Nursing Theory Assignment

Choose a middle-range theory or grand theory that, in your opinion, can be applied to practice. What are the assumptions underpinning this theory? Discuss how this theory finds application in your area of practice.

Ok. This school makes me confused. The summary of this week they posted like this:

SUMMARY:

This week introduced you to grand theories and middle-range theories that serve to articulate the voice of nursing within healthcare.

Here are the key points covered:

Grand theories are comparatively more abstract than middle-range theories since they are at a higher level of abstraction. Compared to grand theories, middle-range theories are made up of limited number of concepts that lend themselves to empirical testing. All theories help to explain human health behavior. Nursing Theory Assignment

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• Sister Callista Royï’s adaptive model theory is built on the conceptual foundation of adaptation. It identifies the positive role that nursing plays in the promotion and enhancement of client adaptation to environments that facilitate the healing process.
• Leiningerï’s culture care theory is pertinent in the current multicultural healthcare environment where nurses are exposed to diverse cultures.
• Penderï’s health promotion and disease prevention theory can be called as a “direction setting exercise” for nursing professionals. It believes in fostering the spirit of health promotion and disease and risk reduction.

 

From the chapter, Models and Theories Focused on Nursing Goals and Functions, read the following: The Health Promotion Model: Nola J. Pender

From the chapter, Models and Theories Focused on a Systems Approach, read the following:

The Roy Adaptation Model

From the chapter, Models and Theories Focused on Culture, read the following:

Leininger’s Cultural Care Diversity and Universality Theory and Model

SO, THAT IS WHY I ASSUMED THAT HAS TO BE ONE OF THEM (Pender, Roy Adaptaion or Leininger) Nursing Theory Assignment

ANYWAY, I AM PUTTING INFORMATION TOGETHER.

 

 

Week 4 Chapter 17

 

Models and Theories Focused on Nursing Goals and Functions

 

The Health Promotion Model: Nola J. Pender

Background

Nola J. Pender was born in 1941 in Lansing, Michigan. She graduated in 1962 with a diploma in nursing. In 1964, Pender completed a bachelor’s of science in nursing at Michigan State University. By 1969, she had completed a doctor of philosophy in psychology and education. During this time in her career, Pender began looking at health and nursing in a broad way, including defining the goal of nursing care as optimal health.

In 1975, Pender published a model for preventive health behavior; her health promotion model first appeared in the first edition of the text Health Promotion in Nursing Practice in 1982. Pender’s health promotion model has its foundation in Albert Bandura’s (1977) social learning theory (which postulates that cognitive processes affect behavior change) and is influenced by Fishbein’s (1967) theory of reasoned action (which asserts that personal attitudes and social norms affect behavior). Nursing Theory Assignment

Pender’s Health Promotion Model

McCullagh (2009) labeled Pender’s health promotion model as a middle-range integrative theory, and rightly so. Fawcett (2005) decisively presented the difference between a conceptual model for nursing and a model for middle-range theory. A model for middle-range theory is usually a graphic representation or schematic diagram of a middle-range theory. McCullagh’s (2009) rationale for labeling Pender’s model a middle-range integrative theory is that it portrays the multidimensionality of persons interacting with their interpersonal and physical environments as they pursue health while integrating constructs from expectancy-value theory and social cognitive theory with a nursing perspective of holistic human functioning (Pender, 1996). With the third edition of Health Promotion in Nursing Practice (1996), Pender revised the health promotion model significantly. This revised model is the subject of the discussion in this chapter.

Pender’s health promotion model includes three major categories: (1) individual characteristics and experiences, (2) behavior-specific cognitions and affect, and (3) behavioral outcome. Each of these categories will be considered here separately. Nursing Theory Assignment

The first category includes each person’s unique personal characteristics and experiences, which affect that individual’s actions. Significant components within this category are prior related behavior and personal factors. Prior related behavior is important in influencing future behavior. Pender proposed that prior behavior has both direct and indirect effects on the likelihood of engaging in health-promoting behaviors. In particular, past behavior has a direct effect on the current health-promoting behavior through habit formation: Habit strength increases each time a behavior occurs. Prior behavior is proposed to indirectly influence health-promoting behavior through perceptions of self-efficacy, benefits, barriers, and activity-related affect or emotions (Pender, Murdaugh, & Parsons, 2006). Personal factors include biological factors such as age, body mass index, pubertal status, menopausal status, aerobic capacity, strength, agility, or balance; psychological factors include self-esteem, self-motivation, and perceived health status; and sociocultural factors include race, ethnicity, acculturation, education, and socioeconomic status. Some personal factors are amenable to change, whereas others are immutable (Pender et al., 2006). Nursing Theory Assignment

The second category encompasses behavior-specific cognitions and affect, which serve as behavior-specific variables within the health promotion model. Behavior-specific variables are considered to have motivational significance. In the health promotion model, nursing interventions target these variables because they are amenable to change. The behavior-specific cognitions and affect identified in the health promotion model include (1) perceived benefits of action, (2) perceived barriers to action, (3) perceived self-efficacy, and (4) activity-related affect. Other cognitions fall into the category of interpersonal influences and situational influences. Sources of interpersonal influences on health-promoting behaviors include family, peers, and healthcare providers. Interpersonal influences include norms, social support, and modeling; they shape the person’s tendency to participate in health-promoting behaviors. Situational influences on health-promoting behavior include perceptions of available options, demand characteristics, and aesthetic features of the environment. Within Pender’s model, nursing plans are tailored to meet the needs of diverse patients based on assessment of prior behavior, behavior-specific cognitions and affect, interpersonal factors, and situational factors (Pender et al., 2006, pp. 54–56).

The third category within Pender’s model is the behavioral outcome. Commitment to a plan of action marks the beginning of a behavioral event. This commitment propels the person into the behavior unless that action is confounded by a competing demand that cannot be avoided or a competing preference that is not resisted. Interventions in the health promotion model focus on raising consciousness related to health-promoting behaviors, promoting self-efficacy, enhancing the benefits of change, controlling the environment to support behavior change, and managing the barriers to change. Health-promoting behavior, which is ultimately directed toward attaining positive health outcomes, is the product of the health promotion model (Pender et al., 2006, pp. 56–63).

Major Concepts of Nursing According to Pender

Person

The person in the health promotion model refers to the individual who is the primary focus of the model. In Pender’s model, each person has unique personal characteristics and experiences that affect subsequent actions. It is recognized that individuals learn health behaviors within the context of the family and the community, which explains why the model for assessment includes components and interventions at the family and community levels, as well as the individual level (Pender, Murdaugh, & Parsons, 2002, 2006). This is taken a step further in the latest edition (Pender, Murdaugh, & Parsons, 2011), in which the term client refers to individuals, families, and communities who are all viewed as active participants in health promotion. Nursing Theory Assignment

Environment

In the health promotion model, the environment encompasses the physical, interpersonal, and economic circumstances in which persons live. The quality of the environment depends on the absence of toxic substances, the availability of restorative experiences, and the accessibility of human and economic resources needed for healthful living. Socioeconomic conditions such as unemployment, poverty, crime, and prejudice have adverse effects on health, whereas environmental wellness is manifested by balance between human beings and their surroundings (Pender et al., 2006, p. 9; Pender et al., 2011, p. 8).

Health

Health is viewed as a positive high-level state. According to Pender, the person’s definition of health for himself or herself is more important than any general definition of health (Pender et al., 2006; Sakraida, 2010). Health is viewed in the context of health promotion and disease prevention. Health promotion is behavior that is motivated by a desire to increase well-being and optimize human health potential, whereas disease prevention or health protection is behavior motivated by a desire to actively avoid illness, detect illness early, or maintain functioning within the constraints of illness (Pender et al., 2011, p. 5). Health promotion is viewed as a multidimensional concept that includes the dimensions of the individual, the family, the community, socioeconomic status, cultural factors, and environmental factors (Pender et al., 2011, pp. 6–8). Nursing Theory Assignment

Nursing

The role of the nurse in the health promotion model revolves around raising consciousness related to health-promoting behaviors, promoting self-efficacy, enhancing the benefits of change, controlling the environment to support behavior change, and managing the barriers to change (Pender et al., 2006, pp. 57–63). A major function of the APN role is the focus on health promotion. This model serves as a significantly pragmatic process for APNs to use to encourage health-promoting behaviors by patients and to address the benefits of change.

Analysis of the Health Promotion Model

The analysis and critique presented here comprise an examination of assumptions and propositions, as well as the analysis of clarity, simplicity, generality, empirical precision, and derivable consequences of Pender’s health promotion model.

Assumptions of the Health Promotion Model

Assumptions of the health promotion model reflect both nursing and behavioral science perspectives. The seven major assumptions emphasize the active role of the patient in shaping and maintaining health behaviors and in modifying the environmental context for health behaviors:

1. Persons seek to create conditions of living through which they can express their unique human potential.
2. Persons have the capacity for reflective self-awareness, including assessment of their own competencies.
3. Persons value growth in directions viewed as positive and attempt to achieve a personally acceptable balance between change and stability.
4. Persons seek to actively regulate their own behavior.
5. Persons in all their biopsychosocial complexity interact with the environment, both progressively transforming the environment and being transformed over time.
6. Health professionals constitute a part of the interpersonal environment, which influences persons throughout their life span.
7. Self-initiated reconfiguration of person–environment interactive patterns is essential for behavior change (Pender et al., 2002, p. 63). Nursing Theory Assignment

Propositions of the Health Promotion Model

The health promotion model is based upon 14 theoretical propositions. These theoretical relationship statements provide a basis for research related to health behaviors:

1. Prior behavior and inherited and acquired characteristics influence health beliefs, affect, and enactment of health-promoting behavior.
2. Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits.
3. Perceived barriers can constrain commitment to action (a mediator of behavior), as well as actual behavior.
4. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of behavior.
5. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior.
6. Positive affect toward a behavior results in greater perceived self-efficacy, which can, in turn, result in increased positive affect.
7. When positive emotions or affect are associated with a behavior, the probability of commitment and action are increased.
8. Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior, expect the behavior to occur, and provide assistance and support to enable the behavior.
9. Family, peers, and healthcare providers are important sources of interpersonal influence who can increase or decrease commitment to and engagement in health-promoting behavior.
10. Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior.
11. The greater the commitment to a specific plan of action, the more likely health-promoting behaviors will be maintained over time.
12. Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention.
13. Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and thus preferred over the target behavior.
14. Persons can modify cognitions, affect, and the interpersonal and physical environments to create incentives for health actions (Pender et al., 2002, pp. 63–64). Nursing Theory Assignment

Analysis: Clarity, Simplicity, Generality, Empirical Precision, and Derivable Consequences

Pender’s health promotion model was formulated using inductive reasoning with existing research, which is a common approach to the building of middle-range theories. The research used to derive the model was based on adult samples that included male, female, young, old, well, and ill populations; this design allows the model to be generalized easily to adult populations (Sakraida, 2010).

The health promotion model is simple to understand, because it uses language familiar to nurses. The concept of health promotion is also popular in nursing practice and, therefore, is a practical principle for APNs’ use. The relationships among the factors are linked, and relationships are identified and consistently defined. Considering all of these factors, it is not difficult to see why Pender’s model is popular with practicing nurses and is frequently used as a tool in research. Nevertheless, it has not been used extensively in nursing education, where the emphasis is on illness care in acute care settings (Sakraida, 2010). Nursing Theory Assignment

Discussion

Pender identified health promotion as a key global goal for the 21st century (Pender et al., 2011) and, through development of the health promotion model, has assisted in the delineation of the role of nursing in meeting that goal. Although Pender has now retired, her work on the health promotion model continues. Pender views the nurse’s role in health promotion as more important than ever considering existing health disparities and the challenges of our current healthcare system (Pender et al., 2011). The current scenario of increasing costs for health care associated with episodic illness treatment increases in chronic, preventable conditions within the population, and the focus on managing healthcare costs provide ample incentive to further explore the concepts of the health promotion model as APNs strive to improve health outcomes in patient populations.

Summary

Although the four nursing models described in this chapter were conceived by four very different nurses whose careers spanned more than a century, they share a common thread: All place emphasis on the function of nursing practice in relation to health outcomes. For Nightingale, the function of nursing is to alter the environment to allow for action on the person by natural laws of health; for Henderson, the function of nursing is to assist the person to perform activities to gain independence; for Johnson, the function of the nurse is to impose external regulatory mechanisms in order to facilitate restoration of system balance; and for Pender, the nurse functions to raise consciousness, promote self-efficacy, and control the environment to allow for behavior change resulting in high-level health. All four of these nursing models also conceptualize the goal of nursing care as a restoration of the health of the patient, however differently the concept of health—or, for that matter, the concept of the patient—may be defined in their respective theories. Nursing Theory Assignment

Discussion Questions

1. Nightingale and Henderson considered the discipline of nursing to be both an art and a science. Esthetic patterns of knowing and empirical patterns of knowing both constitute complex yet divergent ways of thinking. How can the APN perform simultaneously from an esthetic perspective and a perspective based on empiricism?
2. Johnson’s behavioral system model has been used in practice and research; as a result, multiple adaptations of this model have appeared in the literature. In response to these additions and alterations, Johnson (1990, p. 27) stated, “[T]hese changes are such that they alter the fundamental nature of the behavioral system as originally proposed, and I do not agree with them.” Does a theory belong to the nurse theorist or to the discipline of nursing? Who has the right to add to or alter a theory? Should a theory be altered based on research evidence even if the original nurse theorist is not in agreement, or should the theory be maintained intact as a historical record?
3. Considering a patient scenario from advanced nursing practice and using a middle-range theory such as the health promotion model, demonstrate the connection and reciprocal relationship between theory, practice, and research.
4. The theories presented in this chapter, although they view nursing from various perspectives, have brought to light these theorists’ identification and development of the concepts of interest, thereby influencing the evolution of nursing as a discipline and framing nursing knowledge. How has the development of these and other nursing theories helped to frame knowledge and shape the role of the APN? Nursing Theory Assignment

References

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Pender, N. J. (1996). Health promotion in nursing practice (3rd ed.). Stamford, CT: Appleton & Lange.

Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2002). Health promotion in nursing practice (4th ed.). Upper Saddle River, NJ: Prentice Hall.

Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2006). Health promotion in nursing practice (5th ed.). Upper Saddle River, NJ: Prentice Hall.

Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion in nursing practice (6th ed.). Upper Saddle River, NJ: Pearson.

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Sakraida, T. J. (2010). The health promotion model. In A. M. Tomey & M. R. Alligood (Eds.), Nursing theorists and their work (7th ed., pp. 434–453). St. Louis, MO: Mosby.

Selanders, L. C. (1995). Life and times of Florence Nightingale. In C. M. McQuiston & A. A. Webb (Eds.), Foundations of nursing theory: Contributions of 12 key theorists (pp. 421–431). Thousand Oaks, CA: Sage.

Sh elly, J. A., & Miller, A. B. (2006). Called to care: A Christian worldview for nursing (2nd ed.). Downers Grove, IL: InterVarsity Press.

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Tomey, A. M. (2006). Nursing theorists of historical significance. In A. M. Tomey & M. R. Alligood (Eds.), Nursing theorists and their work (6th ed., pp. 54–67). St. Louis, MO: Mosby.

Tooley, S. A. (1910). The life of Florence Nightingale. London, UK: Cassell. Woodham-Smith, C. (1951). Florence Nightingale. New York, NY: McGraw-Hill. Nursing Theory Assignment

 

 

Leininger’s Cultural Care Diversity and Universality Theory and Model

Leininger’s cultural care diversity and universality theory and the sunrise model that depicts her theory are perhaps the most well known in nursing literature on culture and health (Leininger & McFarland, 2006). The theory draws from anthropological observations and studies of culture and cultural values, beliefs, and practices. The theory of transcultural nursing promotes understanding of both the universally held and common understandings of care among humans and the culture-specific caring beliefs and behaviors that define any particular caring context or interaction. According to Leininger, this theory is intended to be holistic: Culture is the specific pattern of behavior that distinguishes any society from others and gives meaning to human expressions of care (Leininger, 2002).

The theory of cultural care diversity and universality is heavily used in education and research. It incorporates the following assumptions about care and caring as they relate to cultural competency (Leininger, 2002): Nursing Theory Assignment

• Care (caring) is essential to curing and healing, for there can be no curing without caring.
• Every human culture has generic, folk, or indigenous care knowledge and practices and usually some professional care knowledge and practices that vary transculturally.
• Culture care values, beliefs, and practices are influenced by and tend to be embedded in the worldview, language, philosophy, religion and spirituality, kinship, social, political, legal, educational, economic, technological, ethno-historical, and environmental contexts of cultures.
• A client who experiences nursing care that fails to be reasonably congruent with his or her beliefs, values, and caring life ways will show signs of cultural conflict, noncompliance, stress, and ethical or moral concern.
• Within a cultural care diversity and universality framework, nurses may take any or all of three culturally congruent action modes: (1) cultural preservation/maintenance, (2) cultural care accommodation/negotiation, and (3) cultural care repatterning/restructuring. Nursing Theory Assignment

According to Leininger, cultural care preservation/maintenance refers to assistive, supportive, facilitative, or enabling professional actions and decisions that help individuals, families, and communities of a particular culture retain and preserve care values so that they can maintain well-being, recover from illness, or face possible handicap or death. Cultural care accommodation/negotiation refers to assistive, supportive, facilitative, or enabling professional actions and potential decisions that help individuals, families, and communities of a particular culture adapt to or negotiate with others for satisfying healthcare outcomes with professional caregivers. Cultural care repatterning/restructuring refers to the assistive, supportive, facilitative, and enabling roles filled by nurses and other healthcare providers to promote actions and decisions that may help the person, family, or community change or modify behaviors affecting their life ways, thereby achieving a new and different health pattern (Leininger & McFarland, 2006). These three action modes are sometimes used with other cultural theories and models.

Leininger recognized the comparative aspects of caring within and between cultures—hence the theory’s acknowledgment of similarities as much as differences in caring in diverse cultures. Her transcultural model has implications for how nurses assess, plan, implement, and evaluate care of people from diverse cultural backgrounds. The sunrise model and theory have clarity, but they are complex. The model has generality for nursing, empirical precision, and derivable consequences. The sunrise model can be found on the Transcultural Nursing Society’s website (http://tcns.org/Theories). Nursing Theory Assignment

The Roy Adaptation Model

The History

Sister Callista Roy recalled that the origins of her adaptation model date back to 1964, when she was a master’s-level student at Mount St. Mary’s College in Los Angeles. In 1970, she published the basic ideas of her conceptual model in an article titled “Adaptation: A Conceptual Framework for Nursing” in Nursing Outlook. In 1971 and 1973, the model was further explained in a chapter of Riehl and Roy’s (1974) book, Conceptual Models for Nursing Practice. A more comprehensive explanation of the model can be found in Roy’s (1976) book, Introduction to Nursing: An Adaptation Model. Further refinements of the model were published in the second edition of that book (Roy, 1984). Roy’s clinical experiences in pediatric nursing and neurological nursing were important influences in the development of her model (Roy, 2009).

The primary influencers for defining the key aspects of Roy’s adaptation model included the systems theory described by von Bertalanffy (1968) and the work of physiological psychologist Harry Helson (1964), who developed adaptation-level theory. Helson proposed that adaptation involves both psychological and physical processes when an individual faces environmental stimuli. He described three kinds of stimuli—focal, contextual, and residual—that come together and result in a pooled effect. Based on those principles, Roy described how adaptation could help people conserve the energy needed to heal and to cope with new life experiences (Roy & Whetsell, personal communication, 2005). Nursing Theory Assignment

The Philosophy and Assumptions

Roy’s (2009) model was based on two underlying philosophical assumptions—humanism and veritivity. Humanism is the “broad movement in philosophy and psychology that recognizes the individual and subjective dimensions of human experiences as central to knowing and valuing” (p. 28). In 1988, Roy introduced the concept of veritivity—“a principle of human nature that affirms a common purposefulness of human existence” (Roy, 1988, as cited in Roy, 2009, p. 27). She described living systems as totalities made of parts that are unified by a purpose, not simply by cause–effect relationships. The veritivity principle is related to four aspects of human society: (1) human existence’s purpose, (2) humankind’s shared purpose, (3) activity and creativity for the common good, and (4) life sense value (Roy & Andrews, 1999).

Roy acknowledged that her spiritual orientation was a meaningful philosophical influence for development of her model. She also became interested in Teilhard de Chardin’s work in 1955, largely because of its characteristic reconciliation of science and spirituality. According to Roy, nurses assume the responsibility of believing in each person’s life purpose (Roy, 2009). People remain together in a common destiny and find sense in mutual relationships established with other persons, the world, and God. Roy emphasized the commonality that underlies people’s unity and diversity (Roy, 2006). Activity and creativity for the common good are involved in veritivity, and each single human being is different from each other human being—that is, each individual has a unique identity (Roy, 2009). The principle of veritivity allows the nurse to meet the social mandate to help change the system by contributing to the common good through the application of knowledge in practice (Roy & Whetsell, personal conversation, 2005). Roy’s last assumption about veritivity is life sense of value; thus the person is the main domain of interest (Roy, 1996). Similarly, Maritain (1966) viewed a person’s life as having a higher value than mere social utility. Nursing Theory Assignment

The Model

Roy’s first three books—published in 1976, 1984, and 1991—highlighted the many colleagues and students who were involved in her work. In 1987, nursing scholars calculated that more than 100,000 nurses were taught by nursing faculty or had graduated from schools that used Roy’s model as a curricular framework (Roy, 1996).

Roy developed the Roy adaptation model while maintaining a unique focus on the changes that occur in the human adaptive system and in the environment. The model’s central feature is adaptation. According to this model, problems in adaptation materialize when the adaptive systems of a person are unable to respond to stimuli from internal or external environments (Roy & Andrews, 1999).

Major Elements

Roy did not define the metaparadigm concepts as human beings (person), health, environment, and nursing. Instead, Roy labeled the major elements as adaptation, person, environment, health, and goal of nursing.

Adaptation. Adaptation is the process and outcome in which individuals and groups become integrated with their environment through conscious choices (Roy, 2009). Adaptive responses promote integrity in terms of human beings’ goals, which are survival, growth, reproduction, mastery, and personal and environmental transformation. All responses that do not contribute to the integrity of the goals of the human system are recognized as ineffective responses. Nursing Theory Assignment

Person. Early in the development of her model, Roy defined the person as “a bio-psycho-social being, in constant interaction with a changing environment” (Roy & Andrews, 1999, p. 19). An expansion of the concept of person along with the addition of groups was incorporated in the 1980s as part of the model, in the adaptation systems. Described as totality made of parts behaving purposefully, the person uses innate and acquired mechanisms for biological, psychological, and social adaptation. These mechanisms serve as the regulator and cognator subsystems for individuals and the stabilizer and innovator subsystems for people in groups (Roy, 2009).

Environment. Environment is defined as “every condition, circumstance and influence surrounding and affecting, particularly mutual, individual and group development and behavior” (Roy, 1984, as cited in Roy & Andrews, 1999, p. 31). The environment includes all focal, contextual, and residual stimuli (see the definitions in the subsection “Stimulus”). Nursing Theory Assignment

Health. Over time, the concepts of Roy’s model were expanded, with health being one of the main foci. In 1964, Roy described health as an inherent dimension of a person’s life and noted how the health–sickness continuum may vary from severe illness to maximum well-being. More recently, Roy has described health as a “state and a process of being and becoming an integrated and whole person” (Roy, 2009, p. 48). The concept of health is unidimensional, whereas the concept of nursing is represented by science and art. In Roy’s systems theory, the scientific assumptions of the model link the adaptation-level theory described by Helson (1964) with the main concepts of her model. Individuals are regarded as holistic, adaptive systems that are more than the sum of their parts and that function as a whole in constant interaction with the environment (Roy & Andrews, 1999). Similar to how a system has inputs, processes, and outputs, people have stimulus inputs and an adaptation level.

Goal of nursing. According to Roy and Andrews (1999), nursing is “the protection, promotion, and optimization of health and abilities, prevention and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (p. 6). The goal of nursing is “to promote the health of individuals and societies” (Roy, 2009, p. 54). In pursuing this goal, nurses integrate specialized knowledge from the applied sciences to formulate health promotion and illness management strategies for people. Nursing knowledge is focused on how people—sick or well—interact with their environments to enhance well-being and flourishing. Nursing Theory Assignment

Adaptive Systems

Adaptive systems include stimuli, adaptation level, and behavior. They are holistic systems that are defined in terms of human beings.

Stimulus. A stimulus is the trigger that provokes a response; it can be viewed as the point of interaction between the human system and the environment (Roy, 2009). The constructs of stimuli in Roy’s model are based on Harry Helson’s work relating to focal, contextual, and residual concepts. The focal stimulus evokes a primary internal or external awareness by the individual or the group, contextual stimuli are additional environmental factors that operate from within or outside the individual, and residual stimuli are other environmental factors that generate effects that may not be readily apparent in a given situation (Roy, 2009). Stimuli can change rapidly and often do so constantly because of the interactions between people and their environment.

Adaptation level. Adaptation level includes three conditions of the human adaptive system: (1) integrated, (2) compensatory, and (3) compromised. As Roy stated, “The level of adaptation conveys that the human adaptive system is not passive in relation to the environment and that the person and the environment are in constant interaction with each other” (Roy, 2009, p. 37). The integrated level means that the structures and functions of the life processes work as one whole to meet the needs of humans. The compensatory level is where the cognator and regulator subsystems for individuals have been activated; or for groups, it is where the stabilizer and innovator subsystems have been activated. The compromised level is initiated in response to the system’s diminishing adaptation, because the integrated and the compensatory levels are no longer working. Nursing Theory Assignment

Behavior. Behavior is defined as internal or external actions and reactions that occur under specific circumstances (Roy, 2009). Behavior is sometimes objectively observed and measured or subjectively reported by individuals or people in groups. Output behavior indicates how well a system can adapt while interacting with the environment—this relationship is the target of nursing interventions.

The behavioral response is evident in the coping process, but it remains independent of this process. The processes involving the human being as an adaptive system underscore the various ways in which people deal with the demands of their environment. These processes specifically focus on those behaviors that meet the goals for adaptation; they relate to responses that promote the integrity of the human system in terms of adaptation goals (Roy & Andrews, 1999). Put simply, the behavioral response can be either adaptive or ineffective, as described in the previous section on model elements. Nursing Theory Assignment

Coping Processes

Coping processes are “innate or acquired ways of interacting with—that is, responding to and influencing—the change environment” (Roy & Andrews, 1999, p. 41). The coping processes include the coping capacity, cognator and regulator subsystems for coping processes, and stabilizer and innovator subsystems for control processes.

Coping capacity. Coping capacity is viewed as an important stimulus to enhance adaptation. One’s coping ability as an adaptive system serves as a significant internal input for the person; output, in contrast, relates to the actual behavior. Coping involves the four dimensions already mentioned: regulator and cognator coping subsystems for individuals, and stabilizer and innovator control subsystems for groups.

Cognator and regulator coping processes. The cognator subsystem for individuals is a coping process that interacts primarily with the other three modes. This system includes four cognitive–emotive channels: (1) perceptual and information processing, (2) learning, (3) judgment, and (4) emotion. Nursing Theory Assignment

The regulator subsystem for individuals constitutes a major coping process that includes an extremely linked physiological mode. The neurochemical and endocrine systems respond unconsciously to stimuli through neural, chemical, and endocrine coping channels; thus, they affect the fluid, electrolyte, and acid–base balance, as well as the endocrine system. These responses are interrelated and act in concert with one another, rather than in isolation, to maintain the equilibrium of the systems.

Stabilizer and innovator control processes. The stabilizer subsystem for groups is a control process associated with systems maintenance involving structures, values, and daily activities to fulfill the purpose of the social system. The innovator subsystem is a control process related to individuals in groups; it encompasses structures and processes associated with personal change and growth within social systems. Nursing Theory Assignment

Adaptive Modes

The coping process responses constitute the outputs of the human adaptive system. These responses are reflected in behaviors, which are interrelated adaptive modes. As such, adaptation is evident in four adaptive modes for individuals: (1) physiological, (2) self-concept, (3) role function, and (4) interdependence. For groups, the four adaptive modes are (1) physical, (2) identity, (3) role function, and (4) interdependence. Thus “behavior in one mode may have an effect on or act as stimulus for one or all the other modes” (Roy & Andrews, 1999, p. 51).

Physiological/physical mode. The physiological mode reflects the way that individuals as physical beings interact with the environment. This mode consists of two components: the physiological mode and the physical mode. The physiological mode pertains to the individual. In this mode, persons manifest the physical processes and activities of living organisms (Roy, 2009). The behavior in this mode represents the physiological manifestations of a person’s cells, organs, and systems. This mode has nine components: five basic needs (oxygenation, nutrition, elimination, activity and rest, and protection) and four processes (senses, fluid and electrolyte balance, neurological function, and endocrine function). The basic need of the physiological mode is physiologic integrity. Nursing Theory Assignment

By comparison, the physical mode relates to “the way the human adaptive system of the group manifests adaptation relative to basic operating resources, that is, participants, physical facilities and fiscal resources” (Roy, 2009, p. 43). The fundamental need of the physical mode is resource adequacy.

The self-concept/group identity mode. The self-concept mode reflects personal aspects of individuals related to behavior. A self-concept is “the composite of beliefs and feelings that an individual holds about him or herself at a given time” (Roy, 2009, p. 44). The basic need for the self is psychic and spiritual integrity—that is, the need to know who one is so that the person can live with a sense of unity and purposefulness in the universe (Roy, 2009). Self-concept includes three components: (1) physical self (body image and body sensations), (2) personal self (self-consistency, self-ideal), and (3) the moral–ethical–spiritual self.

The group identity mode reflects group aspects of behavior. It comprises four subdimensions: (1) interpersonal relationships, (2) group self-image, (3) social milieu, and (4) group culture. The basic need underlying this mode is identity integrity of the group.

The role function mode. Focusing on the roles that the person has in society, the basic needs underlying the role function mode have been identified as social integrity, role clarity, and the need to know who one is in relation to others so that one can act. This mode relates to the function or responsibility that an individual or group has in society.

The individual has three types of roles:

1. A primary role, which is unchangeable because it is based on age, gender, and developmental stage.
2. A secondary role, which is related to the expectations of the individual and the primary role. This role is an important one because it relates to the life project of each individual.
3. A tertiary role, which is temporary, is linked to the first two roles. In general, the tertiary role can change and is derived from the secondary and primary roles. Tertiary roles are freely chosen and often relate to small tasks undertaken in the course of a person’s life.

In relation to groups, Roy (2009) established that the role’s functions are “the vehicle through which the goals of the social system are actually accomplished” (p. 44)—relating to their mission or the tasks associated with the functions of the group. The role function includes the function of administrators and staff, the management of information, and systems for decision making and maintaining order. Nursing Theory Assignment

The interdependence mode. The interdependence mode is the category of behavior related to relationships that individuals and groups establish with others. For individuals, this mode focuses on those interactions through which the individual receives and gives love, respect, and valuation. The basic need of this mode is nurturing relationships. For groups, this category reflects the group’s social context.

The adaptive modes reflect the responses of the coping processes of the individual or group to the focal, contextual, and residual stimuli. These modes are interrelated, such that a response in one mode affects the responses in the other three modes and is expressed in an individual’s behavior. Roy’s adaptation model is a systems model, meaning that it has elements of an “interactional” model. It was developed specifically to be used in caring for individual clients, but it can also be adapted for use with families and communities.

The Nursing Process

When implementing the nursing process according to the Roy adaptation model, human experiences and responses are approached in a nontraditional way. An individual or a group of individuals is viewed as a holistic adaptive system. Stimuli from the internal and external environments trigger the coping processes maintained by the four adaptive modes. The nurse assesses the behavior of the person or group and the influence of the stimuli on behavior; based on this assessment, the nurse then formulates nursing diagnoses.

Roy (2009) viewed the nursing process as relating to human beings as adaptive systems. This process includes six steps: Nursing Theory Assignment

1. Assessment of behavior
2. Assessment of stimuli
3. Nursing diagnosis
4. Goal setting
5. Intervention
6. Evaluation

Assessment of behavior. The first step involves gathering behavioral data. During the assessment, the nurse systematically examines responses in each adaptive mode, uses observational skills, and compares current measurements to preestablished measurements. Effective communication and caring take precedence—an approach that contributes to the effectiveness of nurse–patient interactions.

Assessment of stimuli. The second step of the nursing process is an extension of the first and encompasses the identification of internal and external stimuli affecting particular behaviors. In completing this assessment, the nurse utilizes skills similar to those applied in the first step. Identifying the behavior that threatens the integrity of the system is the primary concern. During the identification process, the nurse pinpoints the focal, contextual, and residual stimuli that influence the response, as well as the adaptation level that contributes to adaptive or ineffective behavior.

Nursing diagnosis. Nursing diagnosis, according to Roy, is a judgment process that confirms the adaptation status of the person or the group. In formulating a diagnosis, the nurse primarily uses critical thinking. The nursing diagnosis must include behaviors with the most relevant influencing stimuli (Roy, 2009, p. 68).

Goal setting. Goal setting entails the establishment of clear statements vis-à-vis the outcomes of nursing care, as well as the time frame for the expected attainment of the goal. Goal setting is established following the nurse’s assessment. The statement of a goal helps it to materialize and ensures that the behavior of the person or the group becomes the focus. Nursing Theory Assignment

Nursing intervention. The nursing intervention step requires that the nurse choose nursing interventions that promote the adaptation process. After the selection of nursing-appropriate interventions, nurses develop an approach to initiate the steps needed to change the focal stimuli and enhance coping abilities.

Evaluation. Evaluation is the last step of the nursing process; it involves an assessment of the effectiveness of the nursing intervention based on the previously established goals. This step could be the last one in the process, but it might also serve as a change agent to begin a new intervention if the previous goal was not achieved.

The most valuable feature of this process is the collaboration between the person or group and the nurse in every step of the nursing process. Under the auspices of the Roy adaptation model, the effectiveness of the intervention depends on the nurse’s knowledge of the situation and the way in which the nurse obtains collaboration from the person or persons involved.

Application of the Model to Education, Research, and Practice

The use of the Roy adaptation model for nursing education is well documented. This model is used not only in the United States, but also in Asia, Europe, South America, Central America, and Mexico. One of the benefits of using the Roy adaptation model in education is that it provides students with a solid structure for thinking in a holistic manner and developing critical thinking skills. Indeed, the benefit of using this model as a framework for nursing practice has been demonstrated throughout the world, although the level of integration of the model into practice varies among hospitals and countries. Roy’s model generally is found to be useful in focusing, organizing, and directing nurses’ thoughts and actions regarding client care, resulting in a perception that the quality of nursing and client outcomes are improved. An example is easing the patient into a state of adaptability to care. The nursing role in this adaptation process is pivotal in maintaining adaptive responses and converting ineffective responses to adaptive ones to achieve health. Nursing Theory Assignment

Research indicates that the Roy adaptation model is a conceptual model of nursing being used in nursing practice in the United States, Japan, Brazil, Colombia, Mexico, Panama, and Peru. Collectively, the studies in these countries demonstrate that using the model leads to better adaptability to care by patients and improved healthcare outcomes (Moreno & Alvarado, 2009).

Literature has shown that the Roy adaptation model is most useful as a tool when used in nursing research. Numerous quantitative and qualitative research studies have been conducted using Roy’s model as a conceptual framework, and several research instruments have been derived from it (Fawcett, 2005). Many middle-range theories can be created and derived from Roy’s conceptual system. A review of the literature revealed that the model has been used in descriptive studies of personal responses to environmental stimuli and correlations between the modes, manifestations of the stimuli, and effects of nursing interventions that are linked to propositions of the model. Nursing Theory Assignment

 

 

NURS 6521 FINAL EXAM (3 VERSIONS) & NURS 6521 MIDTERM EXAM (3 VERSIONS) (100 CORRECT Q & A IN EACH VERSION, TOTAL: 600 Q & A)

 

NURS 6521 Final Exam / NURS6521 Final Exam (Latest): Advanced Pharmacology: Walden University

Walden NURS 6521 Final Exam / Walden NURS6521 Final Exam (Latest): Advanced Pharmacology

· Question 1

 

After 6 months of unsuccessfully   trying to conceive, a 31-year-old woman and her husband have sought a   referral to a fertility specialist in order to explore their options. A nurse   at the clinic should recognize that the woman may benefit from

· Question 2

 

Which of the following would the   nurse include in a teaching plan about the signs and symptoms of   thrombophlebitis and thromboembolism that should be reported by a patient   taking estrogen?

· Question 3

 

A nurse works at a weight   management clinic. To which of the following overweight patients could the   nurse safely administer dextroamphetamine? NURS 6521 FINAL EXAM

 

· Question 4

 

 

A 71-year-old man has just been   prescribed finasteride (Proscar). Which of the following complaints by this   patient most likely indicated a need for this drug?

 

· Question 5

 

A 38-year-old pregnant patient   admits to the nurse that she is an alcoholic and has been consuming alcohol   during her pregnancy. The nurse knows that using alcohol during pregnancy may   result in a child who presents with

 

· Question 6

 

A nurse practitioner orders 150 mg   of oral fluconazole for a patient with vulvovaginal candidiasis. The patient   should expect to take medication

 

· Question 7

 

An oncology nurse is reviewing the   pathophysiology of cancer and is discussing with a colleague the factors that   contribute to the success or failure of a patient’s chemotherapy. Which of   the following cancerous cells is most susceptible to the effects of   chemotherapeutic drugs?

 

· Question 8

 

A middle-aged patient has received   a diagnosis of GI stromal tumor following an extensive diagnostic workup.   Imatinib has been recommended as a component of the patient’s drug regimen.   What patient education should the nurse provide to this patient?

 

· Question 9

 

A 12-year-old boy is being   discharged from the hospital after major surgery. The boy will be taking two   medications at home for an extended period. The nurse who is discharging the   patient should provide medication teaching specifically to

 

· Question 10

 

A patient has been admitted to the   critical care unit with a diagnosis of peritonitis that has necessitated   treatment with gentamicin. As a result, the care team should be cautious when   concurrently administering other medications that may cause

 

· Question 11

 

A 39-year-old woman is receiving   doxorubicin for the treatment of cancer. After each treatment, the patient   has acute nausea and vomiting accompanied by a slightly increased heart rate.   The nurse will advise her to

 

· Question 12

 

A nurse is caring for a patient   with cancer who has been prescribed dronabinol (Marinol) to help reduce   nausea and vomiting from chemotherapy. The nurse will inform the patient that   he or she is taking an oral form of

 

· Question 13

 

A 46-year-old man is receiving a   quinupristindalfopristin IV infusion for a life-threatening infection. Which   of the following would be most important for the nurse to monitor?

 

· Question 14

 

A woman is receiving prolonged   drug therapy during her complicated pregnancy, and it may pose a risk to both   the mother and the fetus. The primary care physician has made dosage   adjustments to minimize adverse effects and prevent toxicity. The nurse   should make sure

 

· Question 15

 

Alprostadil (Caverject), a drug   used to treat erectile dysfunction, has been prescribed to a 42-year-old   patient. When providing education to the patient and his wife, the nurse   should inform the wife about which of the following adverse effects?

 

· Question 16

 

A 36-year-old patient comes to the   clinic and tells the nurse that she suspects that she is pregnant. During the   initial assessment, the nurse learns that the patient is currently taking   medications for diabetes, hypertension, and a seizure disorder. The nurse   would be most concerned about which of the following medications?

 

· Question 17

 

A male patient with a medical   background tells the nurse that he is not satisfied with the oral synthetic   testosterone that has been prescribed for him and he would like to try a   natural form of oral testosterone. Which of the following would be an   appropriate response by the nurse?

 

· Question 18

 

A male patient is trying to decide   if he should use finasteride (Proscar) to treat benign prostatic hypertrophy   (BPH). When providing information about the drug, the nurse will include   which of the following as a risk associated with finasteride therapy?

 

· Question 19

 

A 2-year-old child is diagnosed   with a minor ailment and is to be administered medications at home for 2   weeks. The child lives with his mother, grandmother, and four other children   between the ages of 14 months and 7 years. The home health nurse is asked to   assess the home environment to determine if it is appropriate for the child   to take his medication at home. Which of the following will have the greatest   impact on the nurse’s assessment?

 

· Question 20

 

A 22-year-old woman has given   birth to an infant who exhibits the signs and symptoms of maternal cocaine   use during pregnancy. These signs and symptoms are a result of what   pathophysiological effect of opioid use during pregnancy?

 

· Question 21

 

A 62-year-old patient taking   tamoxifen exhibits increased bone and tumor pain along with a local disease   flare. The nurse interprets this as an indication of which of the following?

 

· Question 22

 

A female patient is prescribed   oprelvekin therapy to treat thrombocytopenia. Which of the following should   the nurse continuously monitor to determine the efficacy and duration of the   oprelvekin therapy?

 

· Question 23

 

The clinical nurse educator who   oversees the emergency department in a children’s hospital has launched an   awareness program aimed at reducing drug errors. What measure addresses the   most common cause of incorrect doses in the care of infants and children?

 

· Question 24

 

A patient has completed 4 weeks of   treatment with epoetin alfa. Which of the following assessment findings would   most strongly indicate that treatment has been effective?

 

· Question 25

 

A patient has been scheduled to   begin treatment with rituximab for non-Hodgkin’s lymphoma. The nurse who will   administer this drug should understand that it targets

 

· Question 26

 

A 15-year-old boy has been   diagnosed with bone cancer after several months of fatigue and pain. What   question should the nurse include in an assessment when trying to minimize   the potential for adverse drug reactions?

 

· Question 27

 

A 30-year-old man with a BMI of 59   has recently been diagnosed with type 2 diabetes mellitus. In light of the   man’s lack of success with weight loss programs in the past, his care   provider has prescribed sibutramine (Meridia). What instructions should the nurse   consequently provide to this patient? NURS 6521 FINAL EXAM

 

· Question 28

 

A 49-year-old farmer who normally   enjoys good health has become seriously ill in recent days and the results of   an extensive diagnostic work up have resulted in a diagnosis of histoplasmosis.   The patient has been admitted to the hospital and has begun treatment with   amphotericin B. The nurse who is providing care for the patient should   prioritize which of the following diagnostic results during his course of   treatment?

 

· Question 29

 

A patient has just received her   first dose of imatinib and the nurse on the oncology unit is amending the   patient’s care plan accordingly. What nursing diagnosis is most appropriate   in light of this addition to the patient’s drug regimen?

 

· Question 30

 

A 20-year-old female patient is   receiving topical clindamycin for acne vulgaris. She develops a rash and   urticaria along with severe itching where the medication is applied. The   nurse will formulate which of the following nursing diagnoses for the   patient?

 

· Question 31

 

Which of the following nursing   actions is most important in achieving successful antimicrobial therapy with   vancomycin?

 

· Question 32

 

A woman who is in the second trimester   of her first pregnancy has been experiencing frequent headaches and has   sought advice from her nurse practitioner about safe treatment options. What   analgesic can the nurse most safely recommend?

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· Question 33

 

A patient receiving high-dose   cisplatin therapy exhibits symptoms of hypomagnesemia. Which of the following   should the nurse suggest to help offset the magnesium losses from the   cisplatin therapy?

 

· Question 34

 

A child is admitted to the burn   unit with second and third degree burns on both arms and part of his or her   face. When administering topical medications to the burned areas, the nurse   should

 

· Question 35

 

An immunocompromised 7-year-old   child was recently discharged home with a peripherally-inserted central line   (PIC line) for home antibiotic therapy. He has now been brought to the   emergency department by his mother and father with signs and symptoms of line   sepsis. Upon questioning, the mother states that she has been removing the   PIC dressing daily and washing the site with warm water and a cloth. What   nursing diagnosis is most appropriate in this situation?

 

· Question 36

 

A 21-year-old female has a history   of irregular menses. She recently became sexually active, and would like to   begin taking oral contraceptives (OCs). The nurse practitioner recognizes   that most likely this patient would benefit from taking which category of   OCs.

 

· Question 37

 

A 3-year-old boy has developed   otitis media and requires antibiotics. In order to increase the chance that   the boy will take his prescribed medication, the nurse should

 

· Question 38

 

A nurse is providing patient   education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus.   Which of the following statements by the patient will alert the nurse that   special instructions regarding insulin are necessary?

 

· Question 39

 

A 28-year-old woman has completed   rituximab therapy for an autoimmune disease. She tells the nurse that she and   her husband would like to start a family. The nurse will advise her to

 

· Question 40

 

A 73-year-old woman has   osteoporosis and is prescribed alendronate. She takes calcium and vitamin D   supplements, drinks lots of water, and has just quit smoking. The nurse   should advise the patient to also

 

· Question 41

 

A nurse is performing patient   education for a woman who has just been prescribed a bisphosphonate. Which of   the following diagnostic and history findings would have prompted the woman’s   care provider to prescribe a bisphosphonate?

 

· Question 42

 

A 20-year-old woman will soon   begin taking oral contraceptives for the first time. What advice should the   nurse provide to this patient?

 

· Question 43

 

A nurse is providing patient   education to a 50-year-old woman who is taking methotrexate (MTX) for breast   cancer. The nurse will instruct the patient to avoid which of the following   drugs?

 

· Question 44

 

A nurse is instructing a   19-year-old female patient on the use of fluconazole for candida vaginitis. A   teaching priority will be to

 

· Question 45

 

A nurse is assessing a patient who   has chronic lymphoblastic myelogenous leukemia. The treatment plan includes   hydroxyurea (Hydrea). The nurse will assess the patient for which of the   following?

 

· Question 46

 

Mr. Singh is a 66-year-old man who   is receiving chemotherapy for the treatment of lung cancer that has   metastasized to his liver. In an effort to prevent infection, Mr. Singh has   been prescribed filgrastim (Neupogen). Which of the nurse’s following   assessment questions most directly addresses a common adverse effect of   filgrastim?

 

· Question 47

 

A preterm neonate received   caffeine for the treatment of apnea. The nurse should monitor the neonate for   which of the following?

 

· Question 48

 

A patient has been prescribed   daptomycin for a complicated skin infection. Which of the following will the   nurse advise the patient to report immediately?

 

· Question 49

 

A 7-year-old child has been taking   tetracycline for a bacterial infection. The nurse will be sure to inform the   parents that this drug could cause

 

· Question 50

 

Sulconazole has been prescribed   for a patient with tinea pedis. The nurse will instruct the patient to use   the topical agent

 

· Question 51

 

A nurse has questioned why a   patient’s physician has prescribed a narrow-spectrum antibiotic rather than a   broad-spectrum drug in the treatment of a patient’s infection. Which of the   following facts provides the best rationale for the use of narrow-spectrum   antibiotics whenever possible?

 

· Question 52

 

A female patient has been   prescribed estrogen therapy. Which of the following will the nurse advise the   patient is a common adverse effect of estrogen therapy?

 

· Question 53

 

A nurse is discussing oprelvekin   therapy with a male patient. Which of the following will the nurse tell the   patient is the most common adverse effect of the drug?

 

· Question 54

 

A man has a demonstrated history   of androgen deficiency and the consequences of this health problem include an   inability to maintain an erection. Which of the following medications would   best address this patient’s erectile dysfunction (ED)?

 

· Question 55

 

A female patient has follicular   non-Hodgkin’s lymphoma and is receiving thalidomide (Thalomid). It will be   most important for the nurse to monitor this patient for which of the   following?

 

· Question 56

 

A nurse has administered   filgrastim to a diverse group of patients in recent months. Which of the   following patients should the nurse observe for extremely elevated white   blood cell counts following administration of the drug?

 

· Question 57

 

A nurse is aware that the concept   of selective toxicity is foundational to antimicrobial therapy. Which of the   following statements most accurately describes selective toxicity?

 

· Question 58

 

A 59-year-old man with a recent   history of erectile dysfunction has been assessed and prescribed sildenafil   (Viagra). When providing patient education to this man, the nurse should tell   him which of the following?

 

· Question 59

 

A nurse has completed a medication   reconciliation of a patient who has been admitted following a motor vehicle   accident. Among the many drugs that the patient has received in the previous   year is rituximab. The nurse would be justified in suspecting the patient may   have received treatment for which of the following diseases?

 

· Question 60

 

A patient asks the nurse   practitioner about food sources such as soybeans and soy products. The nurse   practitioner understands that these foods are considered

 

· Question 61

 

A nurse is providing patient   education to a 23-year-old woman who is starting the norelgestrominethinyl estradiol   transdermal system (Ortho Evra). Because this is the patient’s first time to   use the birth control patch, the nurse will instruct her to apply the patch

 

· Question 62

 

A nurse is explaining the use of   acyclovir therapy to a 72-year-old man. Nephrotoxicity is discussed as a   major adverse effect in older patients. To minimize the risk of the patient   developing this adverse effect, the nurse will advise him to

 

· Question 63

 

Which of the following patients   will be at the greatest risk for anemia and would be the most likely   candidate for epoetin alfa therapy?

 

· Question 64

 

A 35-year-old woman is on a   weight-loss program and is to begin taking sibutramine (Meridia). After   baseline physical data are obtained, the nurse will assess the patient’s   childbearing potential. The nurse will inform the patient that during   sibutramine therapy she should

 

· Question 65

 

The nurse recognizes that the   potential for teratogenic drug effects is not static throughout the prenatal   and postnatal periods. The potential for teratogenic effects is highest   during

 

· Question 66

 

On the advice of her sister, a   52-year-old woman has visited her nurse practitioner to discuss the potential   benefits of hormone replacement therapy in controlling the symptoms of   menopause. Which of the following responses by the nurse is most appropriate?

 

· Question 67

 

A 16-year-old boy is prescribed   cromolyn sodium nasal spray to treat a nasal allergy. To maximize the   therapeutic effects of the drug, which of the following will the nurse   include in instructions to the patient?

 

· Question 68

 

A nurse who provides care on a   pediatric unit of a hospital is aware that the potential for harm as a result   of drug errors is higher among infants and children than adults. This fact is   primarily due to

 

· Question 69

 

A nurse who provides care on a   pediatric medicine unit has conducted a medication reconciliation of a   recently-admitted patient. In light of the fact that the child takes   methylphenidate (Ritalin), the nurse is justified in considering a history of   what health problem?

 

· Question 70

 

A nurse is caring for a   64-year-old female patient who is receiving IV heparin and reports bleeding   from her gums. The nurse checks the patient’s laboratory test results and   finds that she has a very high aPTT. The nurse anticipates that which of the   following drugs may be ordered?

 

· Question 71

 

A 10-year-old boy is taking   dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the   nurse’s priority assessment would be

 

· Question 72

 

A 9-year-old boy was bought to his   primary care provider by his mother with signs and symptoms of hookworm   infection and will be sent home with a prescription for mebendazole. When   provided patient and family education, the nurse should teach the mother with   which of the following measures to avoid reinfection following treatment?

 

· Question 73

 

A 43-year-old man has been   diagnosed with active TB. He is prescribed a multiple drug therapy, including   INH and rifampin. A priority assessment by the nurse will be to monitor which   combination of laboratory test results?

 

· Question 74

 

During ongoing assessment of a   patient receiving 5-FU therapy, the nurse finds the patient’s platelet count   to be 92,000 cellsmm3. The nurse should do which of the following?

 

· Question 75

 

A nurse is discussing with a   58-year-old male patient the causes of erectile dysfunction in men over 50   years of age. Which of the following will the nurse inform the patient is the   primary physical cause of erectile dysfunction of men in this age group?

 

· Question 76

 

A patient has been admitted to the   critical care unit of the hospital with bacterial septicemia that has failed   to respond to initial antibiotic treatment. The patient’s most recent blood   cultures reveal the presence of methicillin-resistant Staphylococcus aureus   (MRSA) in the patient’s blood. The nurse will anticipate that this patient   will likely require intravenous administration of what antibiotic?

 

· Question 77

 

A nurse is instructing a colleague   on how an antimicrobial produces a therapeutic effect. Which of the following   should be included in the nurse’s teaching?

 

· Question 78

 

A 20-year-old woman has been   prescribed estrogen. As with all women taking estrogen, the nurse will   carefully monitor the patient for which of the following?

 

· Question 79

 

A nurse has been assigned to a   55-year-old woman who has a malignant brain tumor. The patient is receiving   her first dose of carmustine. It will be critical for the nurse to observe   for which of the following?

 

· Question 80

 

A man is prescribed ciprofloxacin   to treat a sexually transmitted infection. The nurse will instruct the   patient to

 

· Question 81

 

A 66-year-old man has made an   appointment with his primary care provider to discuss his recent erectile   dysfunction (ED) and has requested a prescription for tadalafil (Cialis)   based on television commercials he has seen. What characteristic of this   patient would most likely contraindicate the use of tadalafil for his ED?

 

· Question 82

 

A nurse is caring for a patient   who is at 28 weeks’ gestation and is receiving terbutaline (Brethine) to   control preterm labor. Which of the following assessment parameters should   the nurse prioritize?

 

· Question 83

 

A patient with non-Hodgkin’s   lymphoma (NHL) will be starting a course of doxorubicin shortly. When   planning this patient’s care, what nursing diagnosis should the nurse prioritize?

 

· Question 84

 

A patient is taking rifampin   (Rifadin) for active TB. When discussing this drug with the patient, the   nurse should stress that

 

· Question 85

 

A nurse is administering rituximab   to a patient via the IV route. The nurse will set the IV pump at 50 mghour   for the first half hour of the initial infusion. If there are not apparent   reactions after 30 minutes of the infusion, the nurse will increase the   dosage every 30 minutes by 50 mghour until the maximum infusion rate reaches   which of the following? NURS 6521 FINAL EXAM

 

· Question 86

 

A 60-year-old patient experienced   a sudden onset of chest pain and shortness of breath and was subsequently   diagnosed with a pulmonary embolism in the emergency department. The patient   has been started on an intravenous heparin infusion. How does this drug   achieve therapeutic effect?

 

· Question 87

 

A patient will soon begin targeted   therapy as a component of her treatment plan for chronic leukemia. The nurse   is conducting health education about this new aspect of the patient’s drug   regimen and the patient has asked about the potential side effects of   treatment. How should the nurse best respond?

 

· Question 88

 

A patient is taking etoposide for   a testicular tumor refractory to treatment. The nursing assessment reveals   that he is also taking warfarin. The nurse must carefully monitor for which   of the following?

 

· Question 89

 

A patient is receiving long-term   clindamycin therapy for a life-threatening infection. The nurse will begin by   monitoring this drug therapy by obtaining

 

· Question 90

 

A patient is prescribed   ganciclovir to treat a CMV infection. An oral dosage is prescribed. To help   increase bioavailability of the drug, the nurse will encourage the patient to   take the medication

 

· Question 91

 

A 29-year-old woman who is   morbidly obese has recently begun a comprehensive, medically-supervised program   of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her   regimen, the patient should be questioned about her intake of

 

· Question 92

 

A patient is pregnant and is at 7   weeks’ gestation. She has type 1 diabetes and has been taking insulin since   she was 13 years old. She asks the nurse if the insulin will be harmful to   her baby. The best response to the patient by the nurse would be

 

· Question 93

 

A nurse is explaining to the   parents of a 6-year-old child suffering from angina why nitroglycerin patches   for chest pain would not be appropriate. Which of the following will the   nurse include in an explanation?

 

· Question 94

 

Mr. Lepp is a 63-year-old man who   was diagnosed with colon cancer several weeks ago and who is scheduled to   begin chemotherapy. He reports to the nurse that he read about the need for   erythropoietin in an online forum for cancer patients and wants to explore   the use of epoetin alfa with his oncologist. Which of the following facts   should underlie the nurse’s response to Mr. Lepp?

 

· Question 95

 

A patient with a diagnosis of   chronic myeloid leukemia has met with her oncologist, who has recommended treatment   with the kinase inhibitor imatinib. What route of administration should the   nurse explain to the patient?

 

· Question 96

 

A nurse is going to administer   medication to an infant using a medicine dropper. The best method is to open the   child’s mouth by gently squeezing the cheeks and placing the drops

 

· Question 97

 

A nurse practitioner orders a   single dose of 2 g Metronidazole orally. How many milligrams will the patient   receive in one dose?

 

· Question 98

 

A patient is being treated for   Mycoplasma pneumoniae pneumonia. She is allergic to penicillin and is being   given azithromycin (Zithromax) in capsule form. The nurse will inform the   patient that she will need to take the capsule

 

· Question 99

 

A nurse is explaining to a   pregnant 21-year-old college student why she cannot continue to take   ibuprofen (Advil) for her headaches. The nurse draws a picture depicting drug   molecules crossing the placental membrane and entering into the fetal circulation.   The nurse tells the patient that the main reason this happens is because

 

· Question 100

 

A patient has been prescribed oral   tetracycline. The nurse will instruct the patient to take the drug

 

NURS 6521 Midterm Exam / NURS6521 Midterm Exam (Latest): Advanced Pharmacology: Walden University

Walden NURS 6521 Midterm Exam / Walden NURS6521 Midterm Exam (Latest): Advanced Pharmacology

1. Which of the following patients demonstrates the clearest indication for treatment with prednisone?

A) A 66-year-old woman whose history of smoking has culminated in a diagnosis of emphysema

B) A 70-year-old man whose rheumatoid arthritis has not responded to OTC pain relievers

C) A 12-year-old boy whose long-standing fatigue and malaise have been attributed to leukemia

D) A 50-year-old woman who is being treated for hypertension with a diuretic and an ACE inhibitor

2. A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is consid- erably higher than the parenteral dose and understands that this due to

A) passive diffusion.

B) active transport.

C) glomerular filtration.

D) first-pass effect.

3. A nurse is caring for a postsurgical patient who has small tortuous veins and had a difficult IV insertion. The patient is now receiving IV medications on a regular basis. What is the best nursing intervention to minimize the adverse effects of this drug therapy?

A) Monitor the patient’s bleeding time

B) Check the patient’s blood glucose levels

C) Record baseline vital signs

D) Monitor the IV site for redness, swelling, or pain

4. A patient is in the clinic after 6 weeks of taking riluzole (Rilutek) for a recent diagnosis of amyotrophic lateral sclerosis. The nurse will priori- tize assessment for which of the following?

A) Weight gain

B) Constipation

C) Increased energy

D) Dizziness

5. A cardiac care nurse is monitoring a patient who is receiving lidocaine (Xylocaine) per IV infusion pump for an acute ventricular arrhythmia associated with an acute MI. Which of the following patient manifesta- tions would cause the nurse to notify the physician immediately?

A) Confusion

B) Headache

C) Nausea

D) Leg cramps A

6. A nurse is caring for a patient who is admitted into the cardiac care unit with acute, decompensated heart failure. Nesiritide (Natrecor) has been ordered. When preparing for administration of the drug, the nurse will

A) add the reconstituted vial of medication to a 1,000 mL IV bag.

B) shake the vial vigorously to mix the medication for reconstitution.

C) administer the initial IV bolus over approximately 60 seconds.

D) use the reconstituted solution within a 36-hour period. C

7. A patient has been prescribed lithium therapy. Which of the following signs and symptoms will the nurse tell the patient to report immediately?

A) Increased urination

B) Muscle twitching

C) Hair loss

D) Increased thirst B

8. A nurse is caring for a patient who has just been diagnosed with Parkinson disease. The patient does not understand how the medication ordered, carbidopa-levodopa, is going to help her condition. Which of the following is the correct response by the nurse?

A) “Carbidopa-levodopa will delay the loss of muscle strength and limb function for several months.”

B) “This drug will change the immune processes in your body to help

 

decrease the tissue damage.”

C) “Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms.”

D) “Your drug therapy will reduce excessive reflex activity causing your muscle spasms and will allow for muscle relaxation.”

C

9. A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following?

A) Chronic diarrhea

B) Dental hygiene practices

C) Headaches

D) Diet B

10. A nurse notes new drug orders for a patient who is already getting several medications. Which of the following is the most important con- sideration when preparing to administer the new drugs?

A) How the patient will feel about new medications added to her drug therapy

B) Possible drug-drug interactions that might occur

C) Any special nursing considerations that the nurse must be aware of

D) If generic preparations of the drugs can be used B

11. A nurse is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following?

A) The amount of the drug that must be given to produce a particular re- sponse

B) How well a drug produces its desired effect

C) A drug’s strength of attraction for a receptor site

D) A drug’s ability to stimulate its receptor B

12. A nurse is conducting a medication resolution of a new resident of a care facility and notes that the woman has been taking neostigmine. The nurse should recognize that the woman may have a history of what

 

health problem?

A) Alzheimer disease

B) Parkinson disease

C) Myasthenia gravis

D) Multiple sclerosis C

13. A 77-year-old man’s chronic heart failure is being treated with a regi- men of quinapril (Accupril) and furosemide (Lasix). Which of the fol- lowing assessment findings would suggest that the loop diuretic is con- tributing to a therapeutic effect?

A) The man’s glomerular filtration rate and creatinine levels are within reference ranges.

B) The man’s heart rate is between 60 and 70 beats per minute with a regular rhythm.

C) The man’s potassium and sodium levels remain with reference ranges.

D) The man’s chest sounds are clear and his ankle edema is lessened. D

14. A nurse explains to a patient that nitroglycerin patches should be ap- plied in the morning and removed in the evening. This medication schedule reduces the potential for

A) adverse effects.

B) nitrate dependence.

C) nitrate tolerance.

D) toxic effects. C

15. A nurse who provides care on a busy medical unit of a large hospital is constantly faced with new drugs on patients’ medication administra- tion records. What strategy should the nurse employ to foster up-to-date information about the nursing management of new or uncommon drugs?

A) Focus on learning about a prototype drug that is characteristic of a larger drug class

B) Identify similarities between new drugs and older drugs that are com- monly used on the unit

C) Commit time and energy during each shift to learning about new drugs

 

D) Liaise with pharmacists and pharmacy technicians who work at the hospital

A

16. A 58-year-old man is admitted to the emergency department. A diag- nosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which of the following drugs?

A) Furosemide

B) Digoxin immune fab

C) Captopril

D) Dopamine B

17. A hospital patient’s physician has prescribed quetiapine (Seroquel) to be administered at bedtime. Being unfamiliar with the medication, the nurse has looked it up in a nursing drug manual and noted that the drug is an antipsychotic that is indicated for the treatment of schizophrenia and bipolar disorder. The patient has no psychiatric history, and upon questioning, the physician states that it is being prescribed to help the patient fall asleep at night. How should the nurse best understand this practice?

A) This off-label use of the drug is prohibited by federal laws and pro- fessional practice standards.

B) This is an appropriate use of the drug, provided it is supported by the literature.

C) This is acceptable if the patient has failed to respond adequately to conventional sleep aids.

D) This is a practice that may negate the physician’s and nurse’s liability insurance.

B

18. A 4-year-old child is brought to the emergency department by her mother. The mother reports that the child has been vomiting, and the nurse notes that the child’s face is flushed and she is diaphoretic. The mother thinks that the child may have swallowed carbachol drops. A di- agnosis of cholinergic poisoning is made. Which of the following drugs would be administered?

 

A) Acetylcholine

B) Atropine

C) Cevimeline

D) Nicotine B

19. A nurse is providing discharge instructions to a patient who will be taking fludrocortisone at home. The nurse will encourage the patient to eat a diet that is

A) low in sodium and potassium.

B) low in sodium, high in potassium.

C) high in iron.

D) low in proteins. B

20. A nurse is developing a care plan for a patient who has multiple scle- rosis. An expected outcome for the patient who is receiving glatiramer would be a decrease in

A) chest pain.

B) fatigue.

C) breathing difficulties.

D) heart palpitations. B

21. An elderly postsurgical patient has developed postoperative pneumo- nia in the days following abdominal surgery and is being treated with a number of medications. Which of the following medications that the nurse will administer has the slowest absorption?

A) A sublingual benzodiazepine that has been prescribed to help the pa- tient sleep

B) An intravenous (IV) antibiotic that is being administered by IV pig- gyback at 150 mL/hour

C) An oral antidepressant that the patient has been taking daily for sev- eral years

D) An intramuscular (IM) injection of an opioid analgesic C

22. A female patient diagnosed with chronic atrial flutter has been pre- scribed verapamil in conjunction with digoxin to control ventricular rate.

 

To enhance the therapeutic effect of the drug, the nurse will instruct the patient to

A) take the medication with meals.

B) avoid grapefruit and grapefruit juice.

C) take an aspirin every day.

D) avoid fresh fruit. B

23. A 28-year-old patient asks his nurse how phenelzine therapy would help him. An appropriate response by the nurse would be

A) “This therapy will help reduce the severity of your bipolar episodes.”

B) “The drug will enable you to gain the appropriate weight.”

C) “The drug will help increase your attention level.”

D) “This therapy will improve your overall mood and increase your so- cial activity.”

D

24. A nurse is creating a plan of care for a 68-year-old woman with a re- cent diagnosis of unstable angina and new prescription for nitroglycerin. Which of the following nursing diagnoses should the nurse prioritize in the planning of this patient’s care?

A) Incontinence, Functional, related to adverse effects of drug therapy

B) Risk for Fluid Volume Deficit related to adverse effects of drug ther- apy

C) Confusion, Acute, related to adverse effects of drug therapy

D) Acute Pain, Headache, related to adverse effects of drug therapy D

25. A nurse is caring for a 38-year-old female patient who just started taking lithium for bipolar disorder. Which of the following outcomes would be most appropriate for this patient?

A) The patient will reestablish and maintain a normal pattern of bowel functioning.

B) The patient will identify appropriate interventions to promote sleep.

C) The patient will identify satisfying and acceptable sexual practices and some alternative ways of dealing with sexual expression.

D) The patient will adopt strategies to maintain proper fluid balance. D

 

26. A nurse is caring for a patient who is taking sodium polystyrene sul- fonate (Kayexalate) therapy. The nurse will monitor for which of the fol- lowing?

A) Cardiac arrhythmias

B) Ventricular arrhythmias

C) Hypokalemia

D) Cardiotoxicity C

27. A nurse is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a patient who has just been admitted. What is the most likely goal of this intervention?

A) To treat sinus bradycardia accompanied by hypotension

B) To resolve the patient’s uncompensated heart failure

C) To treat the patient’s ventricular tachycardia

D) To convert the patient’s atrial fibrillation to normal sinus rhythm D

28. A nurse is working in a women’s hospital where she is caring for a new mother who is experiencing postpartum urinary retention. Bethane- chol (Urecholine) has been ordered. The nurse will observe for which of the following?

A) Bradycardia

B) Hypertension

C) Hypotension

D) Decreased salivation B

29. A 12-year-old child who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for

A) onset of suicidal ideation.

B) weight loss.

C) feelings of grandiosity.

D) decreased sleep. A

30. A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully

 

monitored for

A) dizziness.

B) diarrhea.

C) increased secretions.

D) facial flushing.

A

31. A patient has been admitted to the intensive care unit following a myocardial infarction. His nurse is preparing to administer his ordered medications when she notices that one drug ordered is used for treating seizure disorders. The nurse does not find a history of seizures in the pa- tient’s record NURS 6521 FINAL EXAM The most appropriate action for the nurse is to

A) ask the charge nurse if she knows why the drug has been ordered.

B) look up the drug to see if there are other conditions that the drug could be prescribed for.

C) question the physician about the prescribed medication.

D) call the pharmacist and inquire about therapeutic uses of the drug. C

32. A nurse is aware of the high incidence and prevalence of major de- pression in the population. Which of the following individuals possesses the clearest risk factors for depression?

A) A man who has a history of intravenous drug use and multiple hospi- tal admissions for subsequent infections

B) A woman whose father had a long history of depression before he committed suicide

C) A man who is experiencing significant lifestyle changes after losing his job

D) A woman who has recently begun treatment for idiopathic seizure ac- tivity

B

33. The nurse has been assigned a 49-year-old patient who has acute col- itis, and the nurse just completed gathering data concerning core drug knowledge and core patient variables. To implement nursing manage- ment of drug therapy for this patient, the nurse will then

A) evaluate the outcome of the drug therapy.

B) devise strategies to maximize the therapeutic effects of the drug.

 

C) implement planned nursing actions.

D) assess for data that will indicate interactions between core drug knowledge and core patient variables.

B

34. A nurse has been caring for a 49-year-old man who was hospitalized with recurrent ventricular fibrillation and received IV amiodarone. The man is now scheduled to be discharged on oral amiodarone, and the nurse has just completed discharge instructions. Which of the following statements made by the patient indicates that further instruction is neces- sary?

A) “I will notify my physician if I develop a cough and have difficulty breathing.”

B) “I am going on a cruise next week and plan to just lie in the sun all day and relax.”

C) “I plan to see my ophthalmologist in 2 weeks.”

D) “It is important for me to have my thyroid gland checked regularly.” B

35. A 73-year-old man was diagnosed with Parkinson disease earlier this year and has begun taking carbidopa-levodopa four times daily in an ef- fort to control the signs and symptoms of the disease. The nurse should recognize that this therapeutic effect is achieved by influencing the

A) uptake of acetylcholine.

B) dopamine receptors in the brain.

C) synthesis of epinephrine.

D) sensitivity of beta-2 receptors. B

36. A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglyc- erin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infu- sion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments?

A) Blood pressure

B) Urinary output

C) Heart rate

D) Blood urea nitrogen (BUN)

 

A

37. A patient has been prescribed several drugs and fluids to be given in- travenously. Before the nurse starts the intravenous administration, a pri- ority assessment of the patient will be to note the

A) heart rate.

B) body weight and height.

C) blood pressure.

D) skin surrounding the potential IV site. D

38. Which of the following patients would a nurse determine to be at the greatest risk for quinidine toxicity?

A) A 30-year-old pregnant woman

B) A 44-year-old man diagnosed with cardiac insufficiency

C) A 50-year-old woman with myasthenia gravis

D) A 55-year-old man diagnosed with complete heart block B

39. A nurse is assigned to a patient who is taking lithium. Which of the following drug serum levels would indicate that the patient is at risk for adverse effects of the drug?

A) 0.3 mEq/L

B) 0.6 mEq/L

C) 1.7 mEq/L

D) 1.2 mEq/L C

40. A patient experiencing a serious allergic reaction to a bee sting is brought to the emergency department. The patient’s right hand is swollen, red, and painful. She is extremely upset, short of breath, and the nurse detects wheezing and stridor. The nurse is ordered to administer epinephrine to relieve the patient’s

A) pain and swelling around the sting site.

B) discoloration in her hand.

C) acute anxiety.

D) acute bronchospasm. D

 

41. A nurse is educating a patient who has Parkinson disease and her husband about the possible adverse effects of carbidopa-levodopa. The nurse should emphasize the need for the patient and her husband to mon- itor for any sudden increase in

A) involuntary movements.

B) perspiration.

C) appetite or thirst.

D) mobility.

A

42. A nurse has an order to apply nitroglycerin topically, twice a day. The nurse’s initial action will be to

A) wipe off the previous dose from the patient’s body.

B) don a pair of gloves.

C) place the ointment on an area free of excessive hair and of unbroken skin.

D) wipe off any medication that is on the outside of the medication con- tainer.

B

43. A woman with an inflammatory skin disorder has begun taking pred- nisone in an effort to control the signs and symptoms of her disease. The nurse who is providing care for this patient should prioritize which of the following potential nursing diagnoses in the organization of the pa- tient’s care?  NURS 6521 FINAL EXAM

A) Fluid Volume Excess

B) Constipation

C) Acute Confusion

D) Impaired Gas Exchange A

44. A 38-year-old patient is obese and has abscesses around his inner thigh muscles. He is receiving IV antibiotics, but no improvement has been seen. The patient questions the nurse about the most likely cause for the drug therapy failure. The nurse explains to the patient that the

A) surface area of the abscesses is not large enough for the drug to have the desired therapeutic effect.

B) route of administering the medication should not have been IV.

 

C) distribution of the drug to the area of the abscesses is impaired.

D) distribution of the drug to the thigh muscles is generally impaired, even in healthy individuals.

C

45. A patient is prescribed regular doses of epinephrine. Which of the following nursing diagnoses is related to comfort and would be most ap- propriate for this patient?

A) Imbalanced Nutrition: Less Than Body Requirements

B) Disturbed Sleep Pattern, Insomnia Related to CNS Excitation

C) Disturbed Sensory Perception

D) Ineffective Tissue Perfusion B

46. A 68-year-old female patient who was diagnosed with hypertension 2 weeks ago and was prescribed a new hypertension medication has re- turned to the clinic for a follow-up visit. The nurse notes that the pa- tient’s blood pressure is unchanged from her last clinic visit. When the patient was asked if she was taking the new medication on a regular ba- sis, she stated, “I thought that I was supposed to take the new drug when I had a pounding headache or was in a stressful situation, not all the time.” An appropriate nursing diagnosis for this patient would be which of the following?

A) Knowledge, deficient due to the lack of understanding of treatment regimen

B) Coping, ineffective due to forgetfulness

C) Confusion, acute concerning drug administration

D) Anxiety due to diagnosis of hypertension A

47. A nurse is overseeing the care of a young man whose ulcerative coli- tis is being treated with oral prednisone. Which of the following actions should the nurse take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment?

A) Avoid OTC antacids for the duration of treatment

B) Advocate for intravenous, rather than oral, administration

C) Teach the patient strategies for dealing with headaches

D) Carefully assess the patient for infections

 

D

48. A nurse is performing an admission assessment of an elderly patient who is being admitted to a medical ward from the emergency depart- ment. Which of the following is an open-ended assessment question?

A) “Have you ever had a bad response to a drug that you’ve taken?”

B) “Does anyone in your immediate family have a history of drug aller- gies?”

C) “Are you comfortable with receiving needles?”

D) “What kind of reactions have you had to medications?” D

49. In order to promote therapeutic drug effects, the nurse should always encourage patients to

A) take their medication with meals.

B) take their medication at the prescribed times.

C) increase medication dosages if necessary.

D) use alternative therapy to increase the effects of their medications. B

50. Frequent episodes of exercise-related chest pain have caused a 79- year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient’s age will have what effect on her use of ni- troglycerin?

A) The woman may experience paradoxical vasoconstriction when tak- ing nitroglycerin.

B) Decreased saliva production will inhibit the absorption of the drug in her mucosa.

C) The woman will need to allow more time between doses in order to facilitate absorption.

D) The woman will be more susceptible to hypotension than a younger patient.

D

51. A 47-year-old woman has been diagnosed with open-angle glau- coma. Pilocarpine drops are prescribed. The nurse’s assessment reveals that the patient has worn soft contact lenses for 15 years. The nurse will instruct the patient to

A) apply the contact lenses and wait 5 minutes before applying the

 

drops.

B) remove the contact lenses before applying the drops.

C) apply the drops directly on the contact lenses.

D) stop wearing the contact lenses during the pilocarpine therapy. B

52. A nurse who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who ex- press a willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated?

A) A patient who received treatment for kidney failure due to an over- dose of acetaminophen

B) A patient whose pulmonary embolism was treated with a heparin in- fusion

C) A patient with a history of angina who experienced a non-ST wave myocardial infarction

D) A patient whose stage III pressure ulcer required intravenous antibi- otics and a vacuum dressing

C

53. A patient calls the clinic and reports that he is having chest pain. The patient states that “I’m scared that I am going to die and I’ve been pacing up and down my driveway.” After calming the patient, the initial instruc- tion by the nurse would be to

A) ask the patient to call 911 and wait outside for the ambulance to ar- rive.

B) ask the patient to place a nitroglycerin tablet under his tongue imme- diately.

C) have the patient take his pulse for 1 minute.

D) have the patient go into his house and sit or lie down. D

54. Constipation is a major problem in patients with amyotrophic lateral sclerosis (ALS). The nurse will educate the patient and family to

A) choose a laxative at the local drug store.

B) use prune juice only.

 

C) consult their physician before purchasing a laxative.

D) walk at least 500 yards a day. C

55. A nurse has been assigned to care for a 52-year-old attorney who has hypertension and peptic ulcer disease. Before administering his medica- tions, the nurse must complete an initial assessment. Core patient vari- ables will be obtained from which of the following? (Select all that ap- ply.)

A) The patient’s interview

B) The patient’s medical history

C) The patient’s medical record

D) The patient’s physical examination

E) The patient’s health insurer A, B, C, D

56. A 59-year-old woman has long-standing diagnoses of type 1 diabetes and hypertension and has recently been diagnosed with glaucoma. Her ophthalmologist has prescribed pilocarpine (Akarpine), which will achieve its intended therapeutic effect by which of the following means?

A) By blocking receptors of acetylcholine

B) By increasing synthesis of acetylcholine

C) By directly stimulating cholinergic receptors

D) By stimulating nicotinicN receptors C

57. A woman in her twenties has been accompanied to her primary care provider by her mother, who states that her daughter has been experienc- ing increasingly severe episodes of irritable grandiose behavior. The care provider has consequently begun a treatment regimen that includes pharmacological therapies. This patient is most likely experiencing which of the following mood disorders?

A) Bipolar disorder

B) Dysthymic disorder

C) Major depression

D) Personality disorder A

 

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58. A patient is treated with an antibiotic for an infection in his leg. Af- ter 2 days of taking the antibiotic, the patient calls the clinic and reports that he has a rash all over his body. The nurse is aware that a rash can be an adverse effect of an antibiotic and can be either a biologic, chemical, or physiologic action of the drug, which is an example of

A) pharmacotherapeutics.

B) pharmacokinetics.

C) pharmacodynamics.

D) pharmacogenetics. C

59. A 70-year-old man with diabetes mellitus is taking metoprolol (Lo- pressor) to manage his hypertension. The nurse would be sure to instruct the patient to

A) take his pulse at least four times a day.

B) weigh himself once a week at the same time of the day.

C) avoid smoke-filled rooms.

D) understand the signs and symptoms of hypoglycemia. D

60. A 45-year-old man enters the emergency department complaining of chest pain. The nurse has an order to administer amyl nitrite. The nurse will

A) administer the medication by intramuscular injection.

B) crush the capsule and ask the patient to inhale the vapors.

C) place the tablet under the patient’s tongue.

D) ask the patient to chew the tablet before swallowing. B

61. Mrs. Houston is a 78-year-old woman who resides in an assisted liv- ing facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the as- sisted-living facility about this new drug. What teaching point should the nurse emphasize to Mrs. Houston?

A) The importance of having required laboratory work performed on time

B) The need to take the medication at the same time each day regardless of her heart rate

 

C) The correct technique for using a home blood pressure cuff

D) Timing household activities to coincide with the administration times of her digoxin

A

62. A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain?

A) Call the physician

B) Ask the patient to lie back and try to relax

C) Have the patient swallow a tablet every 5 minutes for 15 minutes

D) Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided

D

63. A nurse on an acute medical unit has rectally administered a dose of sodium polystyrene sulfonate to a patient. What assessment should the nurse prioritize in the 48 hours following the administration of this drug?

A) Monitoring of serum potassium levels

B) Stool testing for occult blood

C) Fluid balance

D) Hemoglobin, hematocrit, and red blood cells A

64. An expected outcome for a patient who has just taken sublingual ni- troglycerin should be

A) increased heart rate and decreased blood pressure.

B) decreased heart rate and decreased blood pressure.

C) increased heart rate and increased blood pressure.

D) decreased heart rate and increased blood pressure. A

65. Which of the following patients should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?

A) A 47-year-old female with hypertension

B) A 52-year-old male with adult-onset diabetes

C) A 17-year-old female with symptoms of an upper respiratory infec-

 

tion

D) A 62-year-old male with gout A

66. Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency?

A) Reduction of severe hypertension

B) Increased level of consciousness

C) Restoration of normal sinus rhythm

D) Resolution of respiratory acidosis C

67. A 53-year-old man has been treated for severe asthma for several years with prednisone. Recently, his physician initiated alternate-day therapy for him. The patient tells the nurse that he would rather take the medication every day to prevent confusion. Which of the following would be the best response by the nurse?

A) “This schedule will be more convenient for you.”

B) “This schedule will enable you to lose weight.”

C) “This schedule will decrease the cost of your medication.”

D) “This schedule allows rest periods so that adverse effects are de- creased but the anti-inflammatory effects continue.”

D

68. A middle-aged male patient has received a diagnosis of amyotrophic lateral sclerosis (ALS) and has begun treatment with riluzole (Rilutek). The patient’s nurse should recognize what goal of this treatment regi- men?

A) Restoration of normal motor nerve function

B) Maintenance of normal mobility and activities of daily living

C) Delaying of tracheostomy or mechanical ventilation

D) Relief of neuropathic pain C

69. A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the following measures has the potential to increase the amount of the free drug that is available to body cells?

A) Giving the drug with food in order to delay absorption

B) Administering the drug in small, frequent doses

 

C) Limiting the patient’s protein intake and encouraging fluids

D) Administering the drug intravenously rather than orally D

70. A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate?

A) The drug will decrease in effectiveness

B) The drug will increase in effectiveness

C) There will be a steady state with no anticipated changes

D) The drug will cause excessive therapeutic effects even when adminis- tered in small doses.

A

71. After seeking care for tremors that have become increasingly severe in recent months, a 71-year-old man has been diagnosed with Parkinson disease and will soon begin treatment with carbidopa-levodopa. Which of the following statements indicates that the patient has an accurate un- derstanding of his new medication?

A) “I’ll have to learn how to modify each dose of carbidopa-levodopa based on how bad my symptoms are that day.”

B) “I’ve read that carbidopa-levodopa is quite short-acting so I’ll have to take it several times a day.”

C) “I’ll make sure to stop taking my other medications so that my car- bidopa-levodopa doesn’t interact with them.”

D) “I’ve heard that it can take up to a year for carbidopa-levodopa to cure someone of Parkinson disease.”

B

72. A nurse is caring for a patient who is taking metoprolol (Lopressor). Which of the following statements would indicate that teaching by the nurse concerning the beta-adrenergic antagonist has been effective?

A) “I may have a very dry mouth while taking this drug.”

B) “I should never stop taking this drug abruptly.”

C) “I can stop walking a mile a day.”

D) “Since I am taking this drug, I no longer need to worry about my diet.”

B

 

73. A female patient has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of pred- nisone to avoid

A) hypokalemia.

B) gastrointestinal problems.

C) adrenal insufficiency.

D) menstrual irregularities. C

74. A 21-year-old man experienced massive trauma and blood loss dur- ing a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what as- sessment should the care team prioritize?

A) Respiratory assessment

B) Arterial blood gases

C) Monitoring of intracranial pressure

D) Cardiac monitoring D

75. A 58-year-old woman was diagnosed with myasthenia gravis many years ago and has been on a regimen of neostigmine (Prostigmin), a re- versible cholinesterase inhibitor. In light of the patient’s drug regimen, a nurse can conclude that the pathophysiology of myasthenia gravis in- volves

A) excessive synthesis and release of acetylcholine at neuromuscular junctions.

B) a lack of functional cholinergic receptors at neuromuscular junctions.

C) an inherent susceptibility to cholinergic crisis.

D) deficient reuptake of acetylcholine. B

76. A nurse has been assigned to a 52-year-old woman who has been hospitalized and has a diagnosis of Parkinson disease. The patient has been taking carbidopa-levodopa for about 1 year. The patient states that she has been having “more side effects from her drugs lately” and the nurse observes that the client appears to be lethargic and have a de- creased attention span. Which of the following would be an appropriate nursing diagnosis based on the statement of the patient and the observa-

 

tions of the nurse?

A) Disturbed Thought Processes

B) Disturbed Sleep Pattern

C) Impaired Physical Mobility

D) Risk for Injury B

77. A patient who is going on a cruise is concerned about motion sick- ness and sees his physician, who prescribes scopolamine. The nurse in- forms the patient that using scopolamine may cause him to experience

A) pupil constriction.

B) drowsiness.

C) diarrhea.

D) urinary incontinence. B

78. A nurse is providing patient education to a female patient who is tak- ing fludrocortisone. The nurse will instruct the patient to monitor which of the following at home?

A) Weight gain

B) Thyroid hormone levels

C) Heart rate

D) Core body temperature A

79. A female patient has been prescribed aminoglutethimide to treat Cushing syndrome. Before therapy begins a priority nursing action would be to review the patient’s

A) current lab results, especially complete blood count.

B) current body weight and height.

C) bilirubin level.

D) last menstrual period. A

80. A nurse is caring for a patient in the critical care unit. Phentolamine (Regitine, OraVerse) has been ordered for the management of tissue necrosis caused by extravasation of parenterally administered drugs. Be- fore administering this drug, the nurse will check the patient’s chart for indications of

 

A) peptic ulcer disease.

B) history of acute myocardial infarction.

C) diabetes mellitus.

D) obesity.

B

81. A 28-year-old man has been taking sertraline for a few months. On a follow-up visit to the clinic, he reports a change in sexual functioning, dizziness, and insomnia. The most appropriate response by the nurse would be

A) “How much of the drug are you taking at one time?”

B) “Have you stopped taking the drug?”

C) “Do you eat a lot of fat in your diet?”

D) “How much alcohol do you consume?” B

82. A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments?

A) Oxygen saturation and respiratory rate

B) Heart rate and blood pressure

C) Level of consciousness and pain level

D) Temperature and respiratory rate B

83. A 59-year-old female patient has been prescribed digoxin. The nurse assigned to the patient will instruct her to avoid which of the following?

A) Grapefruit juice

B) Protein-rich foods

C) One glass of red wine per day

D) OTC cold remedies D

84. A female patient is taking 0.125 mg of digoxin daily for heart fail- ure. At a recent clinic visit she reports that since she has been on the drug, she can breathe better and her heart rate has been around 74 beats per minute. The nurse weighs the patient and notices that she has gained 10 pounds since the digoxin therapy was started. The patient is con- cerned that the additional weight will necessitate an increase in the med-

 

ication. Which of the following is an appropriate response by the nurse?

A) “Yes, the drug dosage will probably have to be increased.”

B) “No, the drug dosage will likely stay the same.”

C) “No, the drug dosage will have to be decreased.”

D) “I don’t know; I will have to ask your physician.” B

85. A middle-aged patient was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, his psychiatrist has prescribed phenelzine NURS 6521 FINAL EXAM. When planning this patient’s subsequent care, what nursing diagnosis should the nurse prioritize?

A) Risk for Ineffective Peripheral Tissue Perfusion related to cardiovas- cular effects of phenelzine

B) Risk for Constipation related to decreased gastrointestinal peristalsis

C) Risk for Infection related to immunosuppressive effects of phenelzine

D) Risk for Injury related to drug-drug interactions or drug-nutrient in- teractions

D

86. A woman in her thirties has been experiencing increasing weakness and the results of an edrophonium (Tensilon) test have resulted in a di- agnosis of myasthenia gravis. The patient’s nurse should anticipate that the patient will benefit from treatment with

A) carbidopa-levodopa.

B) a monoclonal antibody.

C) a dopamine agonist.

D) a cholinesterase inhibitor. D

87. A nurse is caring for a patient admitted to the intensive care unit be- cause of heart failure. The patient is prescribed digoxin. Which of the following nursing diagnoses would be appropriate for this patient?

A) Risk for Hyperthyroidism related to adverse effects of drug therapy

B) Decreased Cardiac Output related to altered cardiac function

C) Acute Pain and Headache related to adverse effects of the drug ther- apy

D) Risk of Constipation related to adverse effects of the drug therapy

 

B

88. Which of the following activities would the nurse expect to complete during the evaluation phase of the nursing process in drug therapy?

A) Compare the outcome expected with the actual patient outcome

B) Reconsider core drug knowledge and core patient variables

C) Ask questions to prepare an effective patient education program

D) Establish a baseline for the patient’s treatment and care A

89. A patient is taking tocainide for a life-threatening ventricular ar- rhythmia. The most serious potential adverse effects involve

A) blood dyscrasias.

B) vertigo.

C) paresthesia.

D) visual impairment. A

90. A nurse in the intensive care unit is caring for a patient in shock and has started IV administration of dopamine (Intropin). For a patient in shock, dopamine helps to

A) decrease heart rate.

B) decrease blood pressure.

C) increase blood pressure.

D) increase body temperature. C

91. A 42-year-old African-American man with congestive heart failure has been prescribed hydralazine-isosorbide. The nurse will closely moni- tor for which of the following?

A) Hypertension

B) Hypotension

C) Decrease in body temperature

D) Increased heart rate B

92. After successful treatment for a myocardial infarction, a 69-year-old man has developed a ventricular arrhythmia. His care team has opted for treatment with a Class II antiarrhythmic. The nurse would understand that this patient is likely to be prescribed

 

A) acebutolol.

B) lidocaine.

C) amiodarone.

D) verapamil. A

93. A patient has been prescribed aminoglutethimide 250 mg PO q6h to increase to 2g daily over the next several weeks. The nurse should rec- ognize that this patient most likely has a diagnosis of

A) Cushing syndrome.

B) Addison disease.

C) diabetes insipidus.

D) an autoimmune condition such as asthma. A

94. A patient has a diagnosis of Parkinson disease, and the physician will prescribe carbidopa-levodopa. Before drug therapy, the patient should be carefully assessed for the presence of

A) macular degeneration.

B) closed-angle glaucoma.

C) peptic ulcer disease.

D) diabetes mellitus. B

95. A normal maintenance dose for digoxin is 0.125 to 0.5 mg/day. In which of the following patients would the nurse most likely administer a lower-than-normal maintenance dose of digoxin?

A) A 25-year-old male with congestive heart failure and atrial fibrilla- tion

B) A 32-year-old female with cardiomegaly

C) A 79-year-old male with cardiomegaly

D) A 42-year-old female with a third heart sound C

96. In which of the following patients would a nurse expect to experi- ence alterations in drug metabolism?

A) A 35-year-old woman with cervical cancer

B) A 41-year-old man with kidney stones

 

C) A 50-year-old man with cirrhosis of the liver

D) A 62-year-old woman in acute renal failure C

97. A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient s heart rate, the nurse should prioritize assessment of the patient’s

A) intake and output.

B) blood pressure.

C) cognition.

D) exercise tolerance. B

98. A nurse is caring for a patient who is taking metoprolol (Lopressor). Which of the following statements would indicate that teaching by the nurse concerning the beta-adrenergic antagonist has been effective?

a. “I may have a very dry mouth while taking this drug.”

b. “I should never stop taking this drug abruptly.”

c. “I can stop walking a mile a day.”

d. “Since I am taking this drug, I no longer need to worry about my diet.”

99. A nurse is developing a care plan for a patient who has multiple scle- rosis. An expected outcome for the patient who is receiving glatiramer would be a decrease in

a. chest pain.

b. fatigue.

c. breathing difficulties.

d. Heart palpitations.

100. An elderly postsurgical patient has developed postoperative pneumo- nia in the days following abdominal surgery and is being treated with a number of medications. Which of the following medications that the nurse will administer has the slowest absorption?

A. A sublingual benzodiazepine that has been prescribed to help the pa- tient sleep

B. An intravenous (IV) antibiotic that is being administered by IV pig- gyback at 150 mL/hour

C. An oral antidepressant that the patient has been taking daily for sev- eral years

D. An intramuscular

The benchmark assesses the following competencies:

1.4 Participate in health care policy development to influence nursing practice and health care.

Research public health issues on the “Climate Change” or “Topics and Issues” pages of the American Public Health Association (APHA) website. Investigate a public health issue related to an environmental issue within the U.S. health care delivery system and examine its effect on a specific population.

Write a 750-1,000-word policy brief that summarizes the issue, explains the effect on the population, and proposes a solution to the issue. Benchmark – Policy Brief

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Follow this outline when writing the policy brief:

1. Describe the policy health issue. Include the following information: (a) what population is affected, (b) at what level does it occur (local, state, or national), and (c) evidence about the issues supported by resources.

2. Create a problem statement.

3. Provide suggestions for addressing the health issue caused by the current policy. Describe what steps are required to initiate policy change. Include necessary stakeholders (government officials, administrator) and budget or funding considerations, if applicable.

4. Discuss the impact on the health care delivery system.

Include four peer-reviewed sources and two other sources to support the policy brief.

Prepare this assignment according to the guidelines found in the APA Style Guide,  An abstract/thesis is required. Benchmark – Policy Brief

As their names imply, the honeyguide bird and the honey badger both share an affinity for honey. Honeyguide birds specialize in finding beehives but struggle to access the honey within. Honey badgers are well-equipped to raid beehives but cannot always find them. However, these two honey-loving species have learned to collaborate on an effective means to meet their objectives. The honeyguide bird guides honey badgers to newly discovered hives. Once the honey badger has ransacked the hive, the honey guide bird safely enters to enjoy the leftover honey.

Much like honeyguide birds and honey badgers, nurses and health professionals from other specialty areas can—and should—collaborate to design effective programs. Nurses bring specialties to the table that make them natural partners to professionals with different specialties. When nurses take the requisite leadership in becoming involved throughout the healthcare system, these partnerships can better design and deliver highly effective programs that meet objectives Advocating For The Nursing Role In Program Design And Implementation

In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.

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To Prepare:

• Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.
• Select a healthcare program within your practice and consider the design and implementation of this program.
• Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation.
• Review the User Guide for Uploading Media in your Blackboard Classroom by accessing the Kaltura Media Uploader on the Left Navigation Bar in preparation to record your narrated video or audio for this Assignment.

The Assignment: (2–3 pages)

In a 2- to 3-page paper, create an interview transcript of your responses to the following interview questions:

• Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?
• Who is your target population?
• What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
• What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design? Advocating For The Nursing Role In Program Design And Implementation
• What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
• Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

Discussion Critique On Theory Applications

• please critique your peers’ works, such as purpose, concepts, assumptions, and theory’s implications for nursing practice, nursing education, and nursing research.  Does each group use concepts and the conceptual framework/theoretical framework/model of the theory to guide the nursing implications?
  

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  Discussion Critique On Theory Applications

• Discuss theory applications from their selected articles.
• Please provide suggestions or opportunities for improvement.
• Ask a challenge question to encourage your peers’ participations and critical thinking, for example a question about a unique situation and theory’s application, such as infection prevention.
• Critique the packet of materials and APA format Discussion Critique On Theory Applications