Structural Versus Strategic Family Therapies

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Structural Versus Strategic Family Therapies

Although structural therapy and strategic therapy are both used in family therapy, these therapeutic approaches have many differences in theory and application. As you assess families and develop treatment plans, you must consider these differences and their potential impact on clients. For this Structural Versus Strategic Family Therapies Assignment, as you compare structural and strategic family therapy, consider which therapeutic approach you might use with your own client families.

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                                        Learning Objectives

Students will:

· Compare structural family therapy to strategic family therapy

· Create structural family maps (Refer to Gerlach (2015) in this week’s Learning  

   Resources for guidance on creating a structural family map.) or LOOK AT THE 

   ATTACHED ONE.

· Justify recommendations for family therapy

                                                     The Assignment

In a 2- to 3-page Structural Versus Strategic Family Therapies paper, address the following:

· Summarize the key points of both structural family therapy and strategic family

therapy.

· Compare structural family therapy to strategic family therapy, noting the

strengths and weaknesses of each.

· Provide an example of a family in your practicum using a structural family map.

Note: Be sure to maintain HIPAA regulations (Refer to Gerlach (2015) in this 

  week’s Learning Resources for guidance on creating a structural family map.) or 

  LOOK AT THE ATTACHED ONE.

· Recommend a specific therapy for the family, and justify your choice using the

Learning Resources

Required Readings

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

  • Chapter 5, “Bowen Family Systems Therapy” (pp.      69–88)
  • Chapter 6, “Strategic Family Therapy” (pp.      89–109)
  • Chapter 7, “Structural Family Therapy” (pp. 110–128)

Gerlach, P. K. (2015). Use structural maps to manage your family well: Basic premises and examples. Retrieved from http://sfhelp.org/fam/map.htm

McNeil, S. N., Herschberger, J. K., & Nedela, M. N. (2013). Low-income families with potential adolescent gang involvement: A structural community family therapy integration model. American Journal of Family Therapy, 41(2), 110–120. doi:10.1080/01926187.2011.649110. Structural Versus Strategic Family Therapies.

Méndez, N. A., Qureshi, M. E., Carnerio, R., & Hort, F. (2014). The intersection of Facebook and structural family therapy volume 1. American Journal of Family Therapy, 42(2), 167–174. doi:10.1080/01926187.2013.794046

Nichols, M., & Tafuri, S. (2013). Techniques of structural family assessment: A qualitative analysis of how experts promote a systemic perspective. Family Process, 52(2), 207–215. doi:10.1111/famp.12025

Ryan, W. J., Conti, R. P., & Simon, G. M. (2013). Presupposition compatibility facilitates treatment fidelity in therapists learning structural family therapy. American Journal of Family Therapy, 41(5), 403–414. doi:10.1080/01926187.2012.727673. Structural Versus Strategic Family Therapies.

Sheehan, A. H., & Friedlander, M. L. (2015). Therapeutic alliance and retention in brief strategic family therapy: A mixed-methods study. Journal of Marital and Family Therapy, 41(4), 415–427. doi:10.1111/jmft.12113

Szapocznik, J., Muir, J. A., Duff, J. H., Schwartz, S. J., & Brown, C. H. (2015). Brief strategic family therapy: Implementing evidence-based models in community settings. Psychotherapy Research, 25(1), 121–133. doi:10.1080/10503307.2013.856044

                                                     Required Media

Psychotherapy.net (Producer). (2010). Bowenian family therapy [Video file]. Mill Valley, CA: Author.

Triangle Productions (Producer). (2001). Brief strategic therapy with couples[Video file]. La Jolla, CA: Author. Structural Versus Strategic Family Therapies.

Performance Appraisal – ideal nursing unit essay

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Performance Appraisal – ideal nursing unit essay

Subjective and Objective Aspects

Discuss the subjective and objective aspects of performance appraisal evaluations and how nurse managers can make these experiences most useful to clinical nurses.

Evaluators

Examine and discuss who should evaluate clinical nurses. Should it be an evaluation by peers, oneself, nurse manager, shift supervisor, physician, nurse extender, and so on? Students should identify who should participate in the performance evaluation process and what their role should be, with a rationale for why they should contribute their feedback.

Analyze the common evaluator errors as defined in the assigned readings and describe each in your own words. Discuss how an evaluator can avoid these nasty pitfalls. Performance Appraisal – ideal nursing unit essay.

Performance Appraisal

In nursing clinical practice, performance appraisals are an integral part of improving performance and not a tool to find weaknesses in practice and punish nurse practitioners. Through collaboration with nurse managers and supervisors, nurses are provided with the opportunity to discuss their clinical performance and to highlight areas that are performed well and those that require support or training. This helps an individual to obtain adequate skills and knowledge to become an exemplary team player (Melnyk et al., 2014). In this paper, I will discuss the objective and subjective aspects that should be included in performance appraisals. A brief discussion of clinical nurse evaluators, the role played by each and the clinical tools that can be used to elicit feedback will also be provided. Performance Appraisal – ideal nursing unit essay.

Subjective and Objective Aspects of Performance Appraisal Evaluations

            When conducting a performance appraisal evaluation, it is necessary to ensure that the likelihood of nurse employees to believe that the entire process is subjective rather than objective is important. Subjective aspects evaluate the performance of a nurse in general while objective aspects evaluate the performance of a nurse against specific established standards (Fan et al., 2015). Subjective features include intangible aspects that a nurse possesses such as personality, communication skills, conflict resolution skills, work quality, teamwork, strengths and weaknesses of nurse practitioners.

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Nurse Managers can make good use of subjective aspects in clinical practice by using the information provided to control how nurses are rewarded and incentivized. Incentives motivate nurses with good performance to become the best and those who perform averagely or minimally to put more effort into their clinical practice (Fan et al., 2015).  Similarly, subjective aspects can be used to identify opportunities for training among nurses. In this context, training can be particular to obtain skills and knowledge in problem-solving, communication or to acquire knowledge about the specific topic area in the nursing field. Nurses can then apply this knowledge and skills in clinical practice to improve treatment outcomes. Performance Appraisal – ideal nursing unit essay.

In the evaluation process, objectivity based on tangible and measurable evidence and this has a less likelihood of biases. Therefore, objective aspects may include, specific ratings on the quantity of work done by a nurse, time to report and leave work, a completion rate of duties assigned among others (Fan et al., 2015).  Objective experiences can be made more useful when making decisions about the allocation of work/duties and promotions. This is because objectives aspects provide more tangible data that can be used to gauge a person’s capability to handle specific tasks.

Evaluators

Clinical nurses should be evaluated by nurse managers. Nurse managers have two roles in clinical practice: to serve as administrative leaders and to provide clinical care. Since they act as in charges, they plan, coordinate and evaluate nursing activities in healthcare settings. According to Fan et al., (2015), nurse managers are experts in their areas of practice and possess exemplary instructional, communication and interpersonal skills to be role models for new graduates, students, and other advancing nurses. Performance Appraisal – ideal nursing unit essay.

In the performance evaluation process, the role of nurse managers should be specific to orientation, training, appraisal and providing feedback. In orientation, nursing students should be provided with a description of the roles and responsibilities they will be performing. They should also engage then in continuous training to develop their skills and capabilities further (Spano-Szekely et al., 2016).  Preferably, they can also identify those with high potential and reward them to progressively inspire good performance. It is mandatory that when evaluating the students, nurse managers provide regular feedback to help the students determine whether additional skills and training are needed for acceptable performance, or whether they exceed expectations. Feedback also helps to minimize instances of poor practice. Possible tools that can be used to provide feedback include the feedback sandwich that starts with positive feedback, negative feedback then closing with specific that build a student’s trust and courage (Helminen et al., 2016).  The situation-behavior-impact is another tool which provides learners with the opportunity to reflect on their actions and what they are required to change. Performance Appraisal – ideal nursing unit essay.

 References

Fan, J. Y., Wang, Y. H., Chao, L. F., Jane, S. W., & Hsu, L. L. (2015). Performance evaluation of nursing students following competency-based education. Nurse education today, 35(1), 97-103.

Helminen, K., Coco, K., Johnson, M., Turunen, H., & Tossavainen, K. (2016). Summative assessment of the clinical practice of student nurses: A review of the literature. International Journal of Nursing Studies, 53, 308-319.

Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., & Fineout‐Overholt, E. (2014). The establishment of evidence‐based practice competencies for practicing registered nurses and advanced practice nurses in real‐world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence‐Based Nursing, 11(1), 5-15.

Spano-Szekely, L., Griffin, M. T. Q., Clavelle, J., & Fitzpatrick, J. J. (2016). Emotional intelligence and transformational leadership in nurse managers. Journal of Nursing Administration, 46(2), 101-108. Performance Appraisal – ideal nursing unit essay.

NURS 6050 week 1 Discussion: Presidential Agendas

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Initial Post

The health care topic that I’ve chosen to explore that has reached the Presidential level is the  Opioid epidemic.  Health care disparities seem to arise daily. Opioid abuse /addiction occurs from the use of prescription drugs, none prescription drugs as well as illegal drugs. Drug abuse has been an ongoing challenge in years past and present.  According to (Murray 2019) “Millions of Americans are impacted by the opioid crises”. People are dying at alarming rates due to opioid over doses. Drug abuse has crippled our neighborhoods and communities for decades and continues to be on the rise.” The misuse of and addiction to opioids including prescription opioids, heroin, and synthetic opiods such as Fentanyl, is a serious problem that affects not only the health of many Americans but social and economic welfare of our country” (National Institute on Drug Abuse [NIDA,2018]). In this forum I will explore the stance of President Bush, Obama, and Trump and their strategic efforts to address this epidemic which continues to be an ongoing concern to date NURS 6050 week 1 Discussion: Presidential Agendas.

Presidential Agendas

According to (Ending America’s Opioid Crises, The White House) “President Trump’s Initiative to Stop Opioid Abuse, unveiled in 2018,  confronting the driving forces behind the opioid crises”. The first part of his plan was to educate American’s on the the dangerousness of abusing opioids. Secondly, he wanted to get better control on how drugs were being imported into the United States. To date the President plans to build a wall on the Mexican boarder, who tends to be a heavy supplier. He also, plans to rid the state of illegal immigrant drug traffickers. His final efforts are to aid those who struggle with addiction with more treatment options. President Trump has allocated billions of funds to address the ongoing concerns of the opioid crises. I agree with his on going efforts to limit access to these drugs both legally and illegally. My only opposition is that I would place more treatment centers in those areas that are largely affected, giving equal access to all that has fallen victim.

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President Obama signed a Bipartisan Bill to Combat Opioid Epidemic. According to (Reilly, 2016) “On July 22, President Barrack Obama signed into law the Comprehensive Addiction and Recovery Act, legislation that is the first of its kind to offer a multifaceted federal response to the prescription opioid and heroin epidemic ravaging communities across the United States”. The purpose of this bill will be to combat the misuse of opioids and ensure that people have access to effective treatment. This plan includes proper surveillance by Medicare prescription drug plans to oversee safe prescribing. According to (Reily,2016) “In 2011, more than 1.7 million Medicare beneficiaries received an opioid dose that put them at increased risk of overdose; nearly a quarter million of them received these high doses for 90 or more consecutive days”. Expanding treatment options is also at the forefront of this plan as well. Commonly compared to President Trump’s plan the Comprehensive Addiction and Recovery Act also addresses the intricate concern of ensuring proper treatment.

In 2002 President Bush announced his drug control strategy. President Busch stated ” We’re determined to limit drug supply, to reduce demand and to provide addicts with effective and compassionate drug treatment” (Bush, 2002). Bush also vowed to fight drug use and substantially those who dealt in drugs. Another effort was to target drug supply, by  calling on the coast guards to increase security at the boarders to limit drugs from coming in overseas. The president also sought help from our Homeland Security Director to examine ways to improve our national boarder management system. President Bush urged Americans to do their part as well and to not misuse and abuse drugs in any way. He also urged parents to do their jobs by educating their children on the importance of staying clear of drugs. I also agree with Presidents Bush’s efforts as well, and although the drug crises has continued to arise I believe with every effort put into place we become a step closer in bridging this problem. My only draw back is that president Bush did not implement in his plan how he would combat the control of prescription opioids which continues to be on the rise.

While opioid addiction continues to be a common place among American’s, as a health care professional I am grateful that this is not only viewed as an addiction but also an illness that requires proper treatment. I believe that it is also important to educate our patients after major surgeries the potential risk of becoming addicted to prescription pain medications. As health care providers we really need to encourage patients to choose the least addictive form of medications possible. I also believe that its important to place treatment centers in the most affected areas and in places were patients can easily access them. I commend all three presidents for their conscious efforts to combat this epidemic. Although American’s continue to struggle with this issue, I believe with the strategies that have been put into place Americans have a greater chance at being liberated from this deadly addiction.

References

Murray, K., (2019).Racial Disparities in Opioid Addiction Treatment in Black and White Populations. Retrieved June,1,2020 from https.//www.addictioncenter.com/news/2019/10/racial-disparities-opioid-addiction-treatment/

Ending America’s Opioid Crises|The White House,(2020). The White House. Retrieved June, 1, 2020, from https://www.whitehouse.gov/opioids/

Reilly, K., (2016). President Obama Signes Bipartisan Bill to Combat Opioid Epidemic . Retrieved on June, 1, 2020, from https://www.pewtrusts.org/en/research-and-analysis/articles/2016/07/22/president-obama-signs-bipartisan-bill-to-combat-opioid-epedimic NURS 6050 week 1 Discussion: Presidential Agendas.

President Bush Announces Drug Control Strategy (2002). Retrieved June, 2, 2020, from https://2001-2009.state.gov/p/inl/rls/rm/8451.htm.

Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.

Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

To Prepare:

  • Review the Resources and reflect on the importance of agenda setting.
  • Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.

By Day 3 of Week 1

Post your response to the discussion question: Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

By Day 6 of Week 1

Respond to at least two of your colleagues* on two different days by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.

 

Discussion – Week 1
COLLAPSE

After reading the discussion question, I had a lot of topics that came to mind. I work in the Emergency Department and we receive a lot of patients who has narcotic addiction and are mentally disabled. So instantly, I wanted to choose between the two but I think that health insurance is a bigger topic and so I decided on that. I have been in this country for 20 plus years and I can say that I have been lucky and blessed that I never had to worry about having insurance. The hospital I currently work at is located in a underserved community where a high percentage of our patients are homeless. Our hospital was built to provide care to these communities and we are able to do so with the help of the government. Yes, we are funded by the government. Due to the pandemic, our hospital is facing a budget cut and we are not really sure whats going to happen to these communities who have leaned on us for support. We have never turned anybody away. We don’t ask if you have money to pay or if you are legal in this country NURS 6050 week 1 Discussion: Presidential Agendas. We serve everyone equally. In my opinion, this is how it should be. We should be a country where we can take care of our people, not based on what insurance they have or if they have papers. With that thought, I will discuss what President Bush, Obama and Trump have done regarding this topic.

President Bush was believed to have strengthened  America’s health care system (The white house, n.d.). The president enacted policies that helped more than 40 million Americans get better access to prescription drugs (The white house, n.d.). He also ensured healthcare was affordable, transparent, portable and efficient by empowering Americans to take charge of their health care decision making, helped provide treatment to nearly 17 million people, increased funding at the National Institutes of health and expanded the trade adjustment assistance program add a tax credit to help lower the price (The white house, n.d.). He also made sure the veterans were included in his policies. He increased funding for their medical care, created a program for seriously-injured members, provided money to support traumatic brain injury patients, and he created the defense center for psychological health (The white house, n.d.).

During the Obama administration, he created Affordable Care Act, also known as Obamacare, which ensures all Americans has health insurance (Health for California, n.d.) During this time, everyone had to have health insurance or you might be subjected to a penalty (Health for California, n.d.) With Obamacare, businesses who has more than 50 employees have to provide health care insurance (Health for California, n.d.) Health insurance also cannot deny a person based on their pre-existing conditions (Health for California, n.d.). More advantages include covering adults over 65 years of age, young adults are added to their parents until age of 26 and the premium is based on your income to ensure they are affordable.

During Trump’s campaign, he already mentioned asking Congress to immediately repeal Obamacare (Atkinson, 2017). On the official white house website (n.d.), it stated:

“Obamacare is hurting American families, farmers, and small business with skyrocketing health insurance cost. Moreover, soaring deductibles and copays have made already unaffordable plans unusable. Close to half of U.S. counties are projected to have only one health insurer on their exchanges in 2018. Replacing Obamacare will force insurance companies for their customers with lower costs and higher-quality service. In the meantime, the President is using his executive authority to reduce barriers to more affordable options for Americans and U.S. businesses.”

What do you think Trump has done?

References

Atkinson, J. (2017). The health care policies of President Trump. Retreived from  https://journal.practicelink.com/reform-recap/the-health-care-policies-of-president-trump/

Health for California (n.d.) Obama Care California. Retreived from  https://www.healthforcalifornia.com/obamacare#:~:text=Obama%20Care%20California,Affordable%20Care%20Act%20(PPACA).&text=Obamacare%20ensures%20all%20Americans%20in,of%20money%20in%20the%20process.

The White House: President George W. Bush. (n.d.) The Bush Record. Retreived from  https://georgewbush-whitehouse.archives.gov/infocus/bushrecord/factsheets/healthcare.html

White house (n.d.). Healthcare. Retreived from  https://www.whitehouse.gov/issues/healthcare/

 

NURS_6050_Module01_Week01_Discussion_Rubric

Excellent Good Fair Poor
Main Posting
45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.
0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3.
First Response
17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100

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Discussion – Week 1
COLLAPSE

The topic I chose for this initial discussion is improving healthcare access in the American Indian population. According to the Indian Health Service (IHS), “The American Indian people have long experienced lower health status when compared with other Americans” (ihs.gov). 28.6% of American Indians under the age of 65 are without health insurance coverage (CDC.gov). Due to economic adversity, inadequate education, poverty, discrimination of health services, cultural differences and poor social conditions, lower life expectancy (approximately 5.5 years less) and disease burden is seen among the American Indian people when compared with other Americans (IHS.gov). The leading causes of death in American Indians include diseases of the heart, malignant neoplasm, unintentional injuries, and diabetes (IHS.gov). Regardless of political affiliation, the past three presidents of the United States, George W. Bush, Barack Obama and Donald Trump, incorporated methods in their administrative agendas regarding access to healthcare in an attempt to improve quality of life for the American Indian people.

President George Bush’s administration pushed to cut funding to healthcare for American Indians, indicating that “urban Indians can find care at community centers” (Indianz, 2007). Democrats and Republicans alike worked to reverse the cut in the 2007 and 2008 budgets. According to the same article, “Urban Indian organizations provide health services such as dental, pharmaceutical, vision, alcohol or mental health treatment, suicide prevention and family wellness” (Indianz, 2007) NURS 6050 week 1 Discussion: Presidential Agendas. By cutting funds to this important organization, American Indians would be without access to healthcare and health services.

President Barack Obama and his administration focused on strengthening the government-to-government relationship with Indian Tribes by implementing Executive Order 13175, “Consultation and Coordination with Tribal Governments” (Obama, 2011). Further, President Obama “signed into law the Affordable Care Act (ACA), which is improving the quality of health care and making it more accessible and affordable for all Americans, including Native Americans” (Obama, 2011). The Obama administration continued to provide resources for the American Indian people by ensuring the ACA implemented new and expanded services available through IHS (Obama, 2011). Additionally, First Lady Michelle Obama launched Let’s Move in Indian Country to ensure healthy and affordable choices of food for children and families and improving opportunities for physical activity (Obama, 2011).

President Donald Trump, considering the recent COVID-19 pandemic, provided multiple resources for American Indians regarding access to healthcare. According to President Trump, in early May 2020, “the CARES Act [was signed] into law, providing $8 billion to address coronavirus preparedness, response, and recover for American Indians” (Trump, 2020). An additional $1 billion was allocated through the IHS to support tribes and tribal organizations in their coronavirus response efforts (Trump, 2020). Continuing with President Obama’s efforts in improving government relationships, President Trump worked to enhance coordination between the Federal Government and tribal leaders. Finally, “President Trump re-activated the White House Council on Native American Affairs to promote economic development and rural prosperity in Indian Country” (Trump, 2020).

As healthcare workers, we are drawn to helping those who are in need, and ensuring our patients have access to the highest level of care. As a registered nurse in a rural area, I often encounter the American Indian population. By keeping myself educated on the government’s agenda regarding access to healthcare for the American Indian people, I can implement change and ensure my community continues to receive the access and resources needed to receive this highest level of care.

 

 

References

Disparities: Fact Sheets. (2019, October). Retrieved June 2, 2020, from https://www.ihs.gov/newsroom/factsheets/disparities/

FastStats – Health of American Indian or Alaska Native Population. (2017, May 3). Retrieved June 2, 2020, from https://www.cdc.gov/nchs/fastats/american-indian-health.htm

Indianz. (2007, March 12). Bush administration takes limited view of Indian health. Retrieved June 2, 2020, from https://www.indianz.com/News/2007/001803.asp

Obama, B. (2011, December 2). Obama Administration Record for American Indians and Alaska Natives. Retrieved June 2, 2020, from https://obamawhitehouse.archives.gov/sites/default/files/docs/american_indians_and_alaska_natives_community_record_0.pdf

Trump, D. J. (2020, May 5). President Donald J. Trump is Protecting the Native American Community as We Combat the Coronavirus. Retrieved June 2, 2020, from https://www.whitehouse.gov/briefings-statements/president-donald-j-trump-protecting-native-american-community-combat-coronavirus/ NURS 6050 week 1 Discussion: Presidential Agendas.

Organizational Analysis essay assignment paper example

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Organizational Analysis essay assignment paper example

Required Deliverables
Parts 1–3 of this five part assessment will guide the recommendations you make in Part 4, and help determine what form of leadership is needed in Part 5.

Part 1: SWOT (Strengths, Weaknesses, Opportunities, Threats) or PEST (Political, Economic, Socio-cultural, Technological) Analysis Table.
Part 2: Brief Organizational Assessment Narrative and Organizational Scorecard Table.
Part 3: Brief Gap Analysis Narrative and Gap Analysis Table.
Part 4: Executive Briefing Report.
Part 5: Brief Leadership Implications Narrative.

Preparation
Before you create and submit your Deliverables, select a familiar health care organization to use in each assessment in this course. Choose the organization where you currently work, an organization where you have previously worked, or an organization where you might like to work in the future. Organizational Analysis essay assignment paper example.

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Directions
Conduct an organizational analysis for your selected organization. Incorporate each of the following parts and be sure you carefully read the requirements for each. Organizational Analysis essay assignment paper example.

Part 1: Environmental Assessment
Conduct a brief environmental analysis using a tool such as SWOT or PEST and summarize your findings in table format. You may choose to do both a SWOT and a PEST (or other) analysis, but you are only required to do one. Include impact from the Affordable Care Act in your analysis.

Part 2: Organizational Assessment
Create a table based on your internal analysis of the organization\’s mission, vision, values, culture, and strategic direction. Then, write a brief narrative in which you explain the organization\’s mission, vision, values, and culture, as well as the current strategic direction. Organizational Analysis essay assignment paper example.

Apply a framework such as the organizational, or balanced, scorecard to measure performance relative to the strategy. Indicate if the strategy fits the external environment.
You may use any table format you wish, but be sure you include 1–2 priority performance indicators, internal benchmarks or targets (be sure you include financial and quality targets), and the four categories.
Note: Part 2 is comprised of your brief narrative and the organizational scorecard in table format.

Part 3: Gap Identification
Select 1–2 priority performance indicators within each of the four major categories: business operations, finance, customer satisfaction, and organizational learning and growth. Organizational Analysis essay assignment paper example.

Identify the performance measurements and internal benchmarks or targets for each of the priority performance indicators. Be sure you include financial and quality targets. Use a table similar to the organizational scorecard to identify the gaps between desired and actual performance. Be sure you integrate the strategic direction and scorecard into your gap identification.
Conduct a gap analysis of actual to benchmark or target outcomes. Refer to and integrate the organizational strategic direction and scorecard. Briefly explain any additional gaps you identified between stated organizational values and actual culture. Organizational Analysis essay assignment paper example.
Note: Part 3 is comprised of your gap identification table and a brief narrative.

Part 4: Leadership Recommendation
Write an executive briefing report in which you clearly and concisely outline evidence-based recommendations to close the identified gaps and better align with organizational strategy and targets. Organizational Analysis essay assignment paper example.

Include within your recommendations the resources that will be needed, such as human, financial, technical, and so on. Be sure that you reference your resources to support your recommendations. Keep in mind that this is an executive briefing report; you want to be thorough while still being concise.
Reference a minimum of five resources in this assessment. Look for professional, scholarly research articles on improving performance in health care organizations, how the Affordable Care Act is affecting health care organizations, and other related topics to use in guiding the recommendations you will make to close the gaps you have identified. Organizational Analysis essay assignment paper example.
Part 5: Leadership Implications
Write a brief narrative in which you explain the role of the organization\’s leader with regard to shaping strategic direction, aligning organizational values and culture, and managing change. What are the critical success competencies needed to achieve desired organizational outcomes? Cite your resources to support your statements.

Additional Requirements
Structure: Include a title page, table of contents, and reference page.
Length: There is no required number of pages. Your length will vary depending on the organization you use. Begin each part of the briefing report on a new page. Your goal—and your challenge—is to provide as much detail and information as possible in a direct and concise way. Organizational Analysis essay assignment paper example.
References: Cite at least five current scholarly or professional resources.
Format: Use APA style for citations and references only. Otherwise, follow the formatting and style conventions of an executive briefing report. Use headings and subheadings as appropriate for a professional document.
Font: Times New Roman font, 12 point. Organizational Analysis essay assignment paper example.

 

PROFICIENT DISTINGUISHED
Analyzes the environmental factors, including the Affordable Care Act, that affect the success of a health care organization. Analyzes the environmental factors, including the Affordable Care Act, that affect the success of a health care organization and grounds the analysis on an in-depth examination of the literature.
Analyzes outcomes relative to the organizational directional strategy. Organizational Analysis essay assignment paper example. Analyzes outcomes relative to the organizational directional strategy and assesses fit with the environment.
Identifies gaps in desired versus actual organizational performance. Identifies gaps in desired versus actual organizational performance and demonstrates in-depth understanding of the relationship between environmental factors and organizational success.
Proposes evidence-based recommendations to close gaps identified in the organizational assessment. Organizational Analysis essay assignment paper example. Proposes evidence-based recommendations to close gaps identified in the organizational assessment and considers the benefits and limitations of each recommendation.
Describes the critical success leadership competencies needed to achieve organizational outcomes. Describes and analyzes the critical success leadership competencies needed to achieve organizational outcomes. Organizational Analysis essay assignment paper example.
Writes coherently, concisely, logically, and with strong support from relevant professional resources, in an appropriate format, with correct grammar, usage, and mechanics as expected of a health care administration professiona Writes coherently, substantively, concisely, logically, and with strong support from relevant professional resources, in a consistently appropriate format, with correct grammar, usage, and mechanics as expected of a health care administration professional.
Organizational Analysis essay assignment paper example

NURS 6512 Week 3 Quiz

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NURS 6512 Week 3 Quiz

  1. Which of the following is a major function of dietary protein?
  2. Which medication is frequently associated with weight gain?
  3. Which of the following is not a characteristic of the plan portion of the problem-oriented medical record?
  4. When recording assessments during the construction of the problem-oriented medical record, the examiner should:
  5. Subjective and symptomatic data are:

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  6. Which of the following is the most accurate reflection of an individual s food intake?
  7. Adult recommended dietary fat intake is _____ % of daily caloric intake. NURS 6512 Week 3 Quiz.
  8. You are using the rule of thumb for advising a 150-pound person regarding the appropriate number of calories to promote weight loss. Your advice is for the person to consume no more than _____ calories.
  9. When recording physical findings, which data are recorded first for all systems?
  10. Deficiency of which of the following is a concern in the vegetarian diet?
  11. The position on a clock, topographic notations, and anatomic landmarks:
  12. Which part of the information contained in the patient s record may be used in court?
  13. A 17-year-old girl presents to the clinic for a sport s physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she:
  14. Under normal circumstances, how much water is lost daily by the body? NURS 6512 Week 3 Quiz.
  15. The recommended minimum daily protein requirement for the normal adult is:
  16. During adolescence, the head size normally increases as a result of:
  17. Mrs. Layton is a 33-year-old patient who has obesity. The majority of adult obesity begins:
  18. Infants born to the same parents are normally within which range of weight of each other?
  19. How much of the weight gained during a normal pregnancy is accounted for by the fetus?
  20. In clinical practice, the Ballard Assessment Tool is used to assess a newborn’s: NURS 6512 Week 3 Quiz.

Nurs 6512 Wk 1 Discussion – Building a Health History

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Nurs 6512 Wk 1 Discussion – Building a Health History

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks. Nurs 6512 Wk 1 Discussion – Building a Health History.For this Discussion, you will take on the role of a clinician who is building a health history for one of the following new patients:

·        76-year-old Black/African-American male with disabilities living in an urban setting

·        Adolescent Hispanic/Latino boy living in a middle-class suburb

·        55-year-old Asian female living in a high-density poverty housing complex

·        Pre-school aged white female living in a rural community. Nurs 6512 Wk 1 Discussion – Building a Health History.

·        16-year-old white pregnant teenager living in an inner-city neighborhood

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To prepare:

With the information presented in Chapter 1 in mind, consider the following:

·        How would your communication and interview techniques for building a health history differ with each patient?

·        How might you target your questions for building a health history based on the patient’s age, gender, ethnicity, or environment?

·        What risk assessment instruments would be appropriate to use with each patient?

·        What questions would you ask each patient to assess his or her health risks?

·        Select one patient from the list above on which to focus for this Discussion. Nurs 6512 Wk 1 Discussion – Building a Health History.

·        Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.

·        Select one of the risk assessment instruments presented in Chapter 1 or Chapter 26 of the course text, or another tool with which you are familiar, related to your selected patient.

·        Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history. Nurs 6512 Wk 1 Discussion – Building a Health History.

Post a 1 page paper APA format  1. a description of the interview and communication techniques you would use with your selected patient.

2. Explain why you would use these techniques.

3 Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient.

4 Provide at least five targeted questions you would ask the patient. Nurs 6512 Wk 1 Discussion – Building a Health History.

Readings

·        Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

o   Chapter 1, “The History and Interviewing Process” (pp. 1–21)

This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability. Nurs 6512 Wk 1 Discussion – Building a Health History.

o   Chapter 26, “Recording Information” (pp. 616–631)

This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.

·        Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.

o   Chapter 1, “Medicolegal Principles of Documentation” (pp. 1–12 and abbreviations, pp. 18)

o   Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–36)

·        Deeks, A., Lombard, C., Michelmore, J., & Teede, H. (2009). The effects of gender and age on health related behaviors. BMC Public Health, 9, 213–220.
Retrieved from the Walden Library databases.

This article describes a study that sought to determine the effects of gender and age on health-related behaviors. In the study, the authors also investigated the effects of screening practices, health beliefs, and perceived future health needs. Nurs 6512 Wk 1 Discussion – Building a Health History.

·        Delpierre, C., Lauwers-Cances, V., Datta, G. D., Berkman, L., & Lang, T. (2009). Impact of social position on the effect of cardiovascular risk factors on self-rated health. American Journal of Public Health, 99(7), 1278–1284.
Retrieved from the Walden Library databases.

This study assessed the influence of education level on the association between self-rated health and cardiovascular risk factors. The authors explain their methods and results, and they provide recommendations for similar studies in different countries and cultures.

·        Lee, D. W., Neumann, P. J., & Rizzo, J. A. (2010). Understanding the medical and nonmedical value of diagnostic testing. Value in Health, 13(2), 310–314.
Retrieved from the Walden Library databases.

The authors of this article detail their attempts to develop a framework for defining the potential value of diagnostic testing. The authors also discuss the implications of their framework for health care delivery systems. Nurs 6512 Wk 1 Discussion – Building a Health History.

·        University of Michigan Medical School. (2003). Geriatric functional assessment.
Retrieved from http://www.med.umich.edu/lrc/coursepages/m1/HGD/GeriatricFunctionalAssess.pdf

This article provides an exercise that emphasizes accurate functional status assessments and effective communication with older patients. The authors recommend tools and techniques to be used when caring for older patients.

Note about Uploading Media:
Please refer to the Kaltura Media Uploader page located in the course navigation menu.. The documents on this page provide guidance on how to upload media for your Health Assessment Videos assignments for this course.

Optional Resources

·        LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw- Hill Medical.

o   Chapter 2, “History Taking and the Medical Record” (pp. 15–33). Nurs 6512 Wk 1 Discussion – Building a Health History.

Application of Data to Problem-Solving discussion

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Module 1: What Is Informatics? (Weeks 1-2)

Laureate Education (Producer). (2018). What is Informatics? [Video file]. Baltimore, MD: Author.

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Learning Objectives

Students will:

Analyze how data collection and access can be used to derive knowledge in a healthcare setting
Analyze the role of the nurse leader in using clinical reasoning and judgement in the formation of knowledge
Explain the role of the nurse as a knowledge worker
Explain concepts of nursing informatics
Create infographics related to nursing informatics and the role of the nurse as a knowledge worker
Due By Assignment
Week 1, Days 1–2 Read/Watch/Listen to the Learning Resources.
Compose your initial Discussion post.
Week 1, Day 3 Post your initial Discussion post.
Begin to compose your Assignment.
Week 1, Days 4-5 Review peer Discussion posts.
Compose your peer Discussion responses.
Continue to compose your Assignment.
Week 1, Day 6 Post at least two peer Discussion responses on two different days (and not the same day as the initial post).
Continue to compose your Assignment.
Week 1, Day 7 Wrap up Discussion.
Week 2, Day 1–6 Continue to compose your Assignment.
Week 2, Day 7 Deadline to submit your Assignment.

 

Learning Resources

Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of k nowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. Application of Data to Problem-Solving discussion

Chapter 1, “Nursing Science and the Foundation of Knowledge” (pp. 7–19)
Chapter 2, “Introduction to Information, Information Science, and Information Systems” (pp. 21–33)
Chapter 3, “Computer Science and the Foundation of Knowledge Model” (pp. 35–62)

Nagle, L., Sermeus, W., & Junger, A. (2017).  Evolving Role of the Nursing Infomatics Specialist. In J. Murphy, W. Goosen, &  P. Weber  (Eds.), Forecasting Competencies for Nurses in the Future of Connected Health (212-221). Clifton, VA: IMIA and IOS Press. Retrieved from https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REF

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

Note: You will access this article from the Walden Library databases.

Required Media

Laureate Education (Producer). (2018). Health Informatics and Population Health: Trends in Population Health [Video file]. Baltimore, MD: Author.

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Credit: Provided courtesy of the Laureate International Network of Universities.

Public Health Informatics Institute. (2017). Public Health Informatics: “translating” knowledge for health [Video file]. Retrieved from https://www.youtube.com/watch?v=fLUygA8Hpfo

 

 

Discussion: The Application of Data to Problem-Solving

In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

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Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

To Prepare:

Reflect on the concepts of informatics and knowledge work as presented in the Resources.
Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.
By Day 3 of Week 1

Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

By Day 6 of Week 1

Respond to at least two of your colleagues* on two different days, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.

*Note: Throughout this program, your fellow students are referred to as colleagues. Application of Data to Problem-Solving discussion

Submission and Grading Information
Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 1

To participate in this Discussion:

Week 1 Discussion

 

NURS_5051_Module01_Week01_Discussion_Rubric

Grid View
List View

Excellent Good Fair Poor
Main Posting

45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

 

40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

 

35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

 

0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness

10 (10%) – 10 (10%)
Posts main post by day 3.

0 (0%) – 0 (0%)

0 (0%) – 0 (0%)

0 (0%) – 0 (0%)
Does not post by day 3.

First Response

17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

 

15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

 

13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Application of Data to Problem-Solving discussion

 

0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response

16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

 

14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

 

12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

 

0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation

5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.

0 (0%) – 0 (0%)

0 (0%) – 0 (0%)

0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Discussion: The Application of Data to Problem-Solving

In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

To Prepare:

Reflect on the concepts of informatics and knowledge work as presented in the Resources.
Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.
By Day 3 of Week 1

Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

By Day 6 of Week 1

Respond to at least two of your colleagues* on two different days, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.

*Note: Throughout this program, your fellow students are referred to as colleagues. Application of Data to Problem-Solving discussion

Submission and Grading Information

NURS 6051 – The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

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The Assignment: (4-5 pages)

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

  • Describe the project you propose.
  • Identify the stakeholders impacted by this project.
  • Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.
  • Identify the technologies required to implement this project and explain why.
  • Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

 

NURS_5051_Module02_Week04_Assignment_Rubric

Excellent Good Fair Poor
In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient care efficiency. Your project proposal should include the following:

·   Describe the project you propose.

·   Identify the stakeholders impacted by this project.

·   Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving, and explain how this improvement would occur. Be specific and provide examples.

·   Identify the technologies required to implement this project and explain why.

·   Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.
77 (77%) – 85 (85%)

The response accurately and thoroughly describes in detail the project proposed.

The response accurately and clearly identifies the stakeholders impacted by the project proposed.

The response accurately and thoroughly explains in detail the patient outcome(s) or patient-care efficiencies that the project proposed is aimed at improving, including an accurate and detailed explanation, with sufficient supporting evidence of how this improvement would occur.

The response accurately and clearly identifies the technologies required to implement the project proposed with a detailed explanation why.

The response accurately and clearly identifies the project team (by roles) and thoroughly explains in detail how to incorporate the nurse informaticist in the project team.

Includes: 3 or more peer-reviewed sources and 2 or more course resources.
68 (68%) – 76 (76%)

The response describes the project proposed.

The response identifies the stakeholders impacted by the project proposed.

The response explains the patient outcome(s) or patient-care efficiencies that the project proposed is aimed at improving, including an explanation, with some supporting evidence of how this improvement would occur.

The response identifies the technologies required to implement the project proposed with an explanation why.

The response identifies the project team (by roles) and explains how to incorporate the nurse informaticist in the project team.

Includes: 2 peer-reviewed sources and 2 course resources.
60 (60%) – 67 (67%)

The response describing the project proposed is vague or inaccurate.

The response identifying the stakeholders impacted by the project proposed is vague or inaccurate.

The response explaining the patient outcome(s) or patient-care efficiencies the project proposed is aimed at improving, including an explanation of how this improvement would occur, is vague or inaccurate, or includes little to no supporting evidence.

The response identifying the technologies required to implement the project proposed with an explanation why is vague or inaccurate.

The response identifying the project team (by roles) and an explanation of how to incorporate the nurse informaticist in the project team is vague or inaccurate.

Includes: 1 peer-reviewed sources and 1 course resources.
0 (0%) – 59 (59%)

The response describing the project proposed is vague and inaccurate, or is missing.

The response identifying the stakeholders impacted by the project proposed is vague and inaccurate, or is missing.

The response explaining the patient outcome(s) or patient-care efficiencies the project proposed is aimed at improving, including an explanation of how this improvement would occur, is vague and inaccurate, includes no supporting evidence, or is missing.

The response identifying the technologies required to implement the project proposed with an explanation why is vague and inaccurate, or is missing.

The response identifying the project team (by roles) and an explanation of how to incorporate the nurse informaticist in the project team is vague and inaccurate, or is missing.

Includes: 1 or fewer resources.
Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.
Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
4 (4%) – 4 (4%)
Contains a few (1-2) grammar, spelling, and punctuation errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) grammar, spelling, and punctuation errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
Uses correct APA format with no errors.
4 (4%) – 4 (4%)
Contains a few (1-2) APA format errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) APA format errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100

 

Module 2: The Role of the Informatics Specialist in Healthcare (Weeks 3-4)

Laureate Education (Producer). (2018). The Nurse Informaticist [Video file]. Baltimore, MD: Author.

 
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Learning Objectives

Students will:
  • Analyze interactions between nurse informaticists, data/technology specialists, and other professionals in healthcare organizations
  • Recommend strategies to improve interactions between nurse informaticists and other professionals
  • Analyze how nursing informatics as a specialty and new technologies impact interactions between nurse informaticists and members of healthcare teams
  • Recommend nursing informatics projects to improve outcomes or efficiencies in healthcare organizations
  • Identify stakeholders impacted by nursing informatics projects
  • Analyze how nursing informatics projects improve outcomes or efficiencies in healthcare organizations
  • Identify technologies required for implementation of nursing informatics projects
  • Analyze the role of the nurse informaticist in nursing informatics project teams
Due By Assignment
Week 3, Days 1–2 Read/Watch/Listen to the Learning Resources.
Compose your initial Discussion post.
Week 3, Day 3 Post your initial Discussion post.
Begin to compose your Assignment.
Week 3, Days 4-5 Review peer Discussion posts.
Compose your peer Discussion responses.
Continue to compose your Assignment.
Week 3, Day 6 Post at least two peer Discussion responses on two different days (and not the same day as the initial post).
Week 3, Day 7 Wrap up Discussion.
Deadline to submit your Assignment.
Week 4, Days 1-6 Continue to compose your Assignment
Week 4, Day 7 Deadline to submit your Assignment

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Learning Resources

Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

  • Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)
  • Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)

Mosier, S., Roberts, W. D., & Englebright, J. (2019). A Systems-Level Method for Developing Nursing Informatics Solutions: The Role of Executive Leadership. JONA: The Journal of Nursing Administration, 49(11), 543-548.

Ng, Y. C., Alexander, S., & Frith, K. H. (2018). Integration of Mobile Health Applications in Health Information Technology Initiatives: Expanding Opportunities for Nurse Participation in Population Health. CIN: Computers, Informatics, Nursing, 36(5), 209-213.

Sipes, C. (2016). Project management: Essential skill of nurse informaticists. Studies in Health Technology and Informatics, 225, 252-256.

Discussion: Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.

In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.

To Prepare:

  • Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty.
  • Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization.

By Day 3 of Week 3

Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

By Day 6 of Week 3

Respond to at least two of your colleagues* on two different days, offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 3

To participate in this Discussion:

Week 3 Discussion

Assignment: The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

In the Discussion for this module, you considered the interaction of nurse informaticists with other specialists to ensure successful care. How is that success determined?

Patient outcomes and the fulfillment of care goals is one of the major ways that healthcare success is measured. Measuring patient outcomes results in the generation of data that can be used to improve results. Nursing informatics can have a significant part in this process and can help to improve outcomes by improving processes, identifying at-risk patients, and enhancing efficiency.

To Prepare:

  • Review the concepts of technology application as presented in the Resources.
  • Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.

The Assignment: (4-5 pages)

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

  • Describe the project you propose.
  • Identify the stakeholders impacted by this project.
  • Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.
  • Identify the technologies required to implement this project and explain why.
  • Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

By Day 7 of Week 4

Submit your completed Project Proposal.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:

Week 4 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 4

To participate in this Assignment:

Week 4 Assignment

NURS 6512 Advanced Health Assessment midterm exam questions and answers

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NURS-6512F-23-Advanced Health Assessment midterm

93%

 

 

Question 1

Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the:

descending aorta.
lower liver border.
upper right kidney ridge.
medial border of the spleen.

B

 

 

 

 

Question 2

Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the:

PACES assessment.
Miller Analogies Test.
Glasgow Coma Scale.
CAGE questionnaire.

D

 

 

Question 3

A brief statement of the reason the patient is seeking health care is called the:

chief complaint.
diagnosis.
medical history.
assessment.

A

 

 

Question 4

A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness you should palpate over the:

sphenoid and frontal sinuses.
maxillary and frontal sinuses.
sphenoid sinuses only.
maxillary sinuses only.

D

 

 

 

Question 5

Which statement is true regarding the relationship of physical characteristics and culture? NURS 6512 Advanced Health Assessment midterm exam questions and answers

To be a member of a specific culture, an individual must have certain identifiable physical characteristics.
Physical characteristics should be used to identify members of cultural groups.
Gender and race are the two essential physical characteristics used to identify cultural groups.
There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics.

D

 

 

Question 6

Inspection of the abdomen should begin with the patient supine and the examiner:

standing at the foot of the table.
seated on the patient’s right.
walking around the table.
standing at the patient’s left.

B

 

 

 

uestion 7

Ms. Otten is a 45-year-old patient who presents with a complaint of weight gain. Which medication is frequently associated with weight gain?

Steroids
Laxatives
Oral hypoglycemics
Diuretics

A

 

 

Question 8

During physical examination of a 30-year-old Chinese man, you notice slight asymmetry of his face. The cranial nerve examination is normal. Your best action is to:

B. perform monofilament testing on the face.
D. record the finding in the patient’s chart.
A. ask the patient if this characteristic runs in his family.
C. consult with the physician regarding laboratory tests needed.

C

 

 

 

Question 9

A fixed image of any group that rejects its potential for originality or individuality is known as a(n):

norm.
acculturation.
stereotype.
ethnos.

C

 

Question 10

Tangential lighting is best used for inspecting skin:

exudates.
color.
contour.
symmetry.

C

 

 

 

 

Question 11

Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4′ 3-cm, rough, elevated area of psoriasis. This is an example of a:

B. patch.
D. papule.
C. macule.
A. plaque.

D

 

 

 

Question 12

During an interview, tears appear in the patient’s eyes and his voice becomes shaky. Initially, you should:

ask the patient what he is upset about.
ask him if he would like some time alone.
offer a tissue and let him know it is all right to cry.
explain to the patient that you will be able to help him more if he can control his emotions.

C

 

 

 

 

Question 13

When communicating with older children and teenagers, you should be sensitive to their:

typical reluctance to talk.
natural urge to communicate.
need for verbal instructions.
desire for adult companionship.

A

Question 14

Expected hair distribution changes in older adults include:

increased terminal hair follicles to the tragus of men’s ears.
more prominent axillary and pubic hair production.
increased terminal hair follicles on the scalp.
more prominent peripheral extremity hair production.

A

 

 

 

Question 15

The examiner’s evaluation of a patient’s mental status belongs in the:

physical examination.
review of systems.
history of present illness.
patient education.

Aa

 

 

 

 

 

 

Question 16

When examining the skull of a 4-month-old baby, you should normally find:

D. overlap of cranial bones.
A. closure of the anterior fontanel.
C. ossification of all sutures.
B. closure of the posterior fontanel.

D

 

 

 

 

Question 17

You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector clockwise, then counterclockwise to compensate for:

astigmatism.
strabismus.
amblyopia.
myopia.

D

 

 

 

 

 

 

Question 18

The most superior part of the stomach is the:

pyloric orifice.

 
body.
pylorus.
fundus.

D

 

 

 

 

 

 

Question 19

Brittle nails are typical findings in:

D. older adults.
C. pregnant women.
A. adolescents.
B. infants.

Older adults

 

 

 

 

Question 20

Which of the following is the most vital nutrient?

Fat
Protein
Water
Carbohydrate

C

 

 

 

 

Question 21

A tool used to screen adolescents for alcoholism is the:

HITS.
CAGE.
CRAFFT.
PACES.

C

 

 

 

 

 

 

Question 22

When taking a history, you should:

use a holistic and eclectic structure.
start the interview with the patient’s family history.
ask the patient to give you any information they can recall about their health.
use a chronologic and sequential framework.

D

 

 

 

 

 

 

Question 23

Ms. G. is being seen for her routine physical examination. She is a college graduate and president of a research firm. Although her exact salary is unknown, she has adequate health insurance. Most of the above information is part of Ms. G.’s _____ history.

past medical
family
personal and social
present problem

C

 

 

 

 

Question 24

Mr. Williams, age 25, has recovered recently from an upper and lower respiratory infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented within which section of his history?

Past medical data
Age-specific data
Social history
Past surgical data

A

 

 

 

 

Question 25

Mr. Jones is a 45-year-old patient who presents for a physical examination. On examination, you note costochondral beading, enlarged skull, and bowed legs and diagnose him with rickets. A deficiency of which fat-soluble micronutrient can result in rickets?

Vitamin  K
Vitamin E
Vitamin A
Vitamin D

D

 

Question 26

Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B vitamin is deficient in patients with pernicious anemia?

B1
B2
B6
B12

D

 

 

 

Question 27

After thorough inspection of the abdomen, the next assessment step is:

percussion.
palpation.
rectal examination.
auscultation.

D

 

 

 

Question 28

You are examining a pregnant patient and have noted a vascular lesion. When you blanche over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a:

A. telangiectasia.
C. petechiae.
B. spider angioma.
D. purpura.

C

 

 

 

 

 

Question 29

Which of the following is the most accurate reflection of an individual’s food intake?

Serum protein assays
Food diary
Twenty-four-hour diet recall
Computerized nutrient analysis

B

 

 

 

 

 

 

 

 

 

 

Question 30

Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:

ask a colleague from the same geographic area if this examination is acceptable.
inform the patient of the reason for the examination and ask if it is acceptable to him.
forego the examination for fear of violating cultural norms.
refer the patient to a provider more knowledgeable about cultural differences.

B

 

 

 

 

 

 

Question 31

Tracheal tug suggests the presence of a(n):

enlarged thyroid.
thoracic carcinoma.
swallowing disorder.
aortic aneurysm.

D

 

 

 

Question 32

As you explain your patient’s condition to her husband, you notice that he is leaning toward you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to:

tell him that you understand his need to be alone.
ask whether he would prefer to speak to the clinician.
tell him that it is all right to be angry.
ask whether he has any questions.

D

 

 

 

 

Question 33

When hearing is evaluated, which cranial nerve is being tested?

IV
VIII
III
XII

B

 

 

 

 

 

Question 34

Nuchal rigidity is most commonly associated with:

A. thyroiditis.
C. Down syndrome.
D. cranial nerve V damage.
B. meningeal irritation.

D

 

 

 

Question 35

The attitudes of the health care professional:

are difficult for the patient to sense.
are largely irrelevant to the success of relationships with the patient.
do not influence patient behavior.
are culturally derived.

D

 

 

Question 36

Macronutrients are so named because they:

form long chemical chains.
have high molecular weights.
are required in large amounts.
tend to increase waist measurements.

C

 

 

 

 

Question 37

White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are:

aphthous ulcers.
Fordyce spots.
leukoedema.
Stensen ducts.

A

 

 

 

Question 38

Which type of speculum should be used to examine a patient’s tympanic membrane?

The shortest speculum available
The smallest speculum that will illuminate the ear
Any speculum that will fit the otoscope head
The largest speculum that will fit comfortably in the ear

D

 

 

uestion 39

To correctly document absent bowel sounds, one must listen continuously for:

5 minutes.
1 minute.
30 seconds.
3 minutes.

A

 

 

 

 

Question 40

Which part of the information contained in the patient’s record may be used in court?

Objective information only
All information
Diagnostic information only
Subjective information only

B

 

 

 

Question 41

A flat, nonpalpable lesion is described as a macule if the diameter is:

greater than 1 cm.
less than 1 cm.
3 cm exactly.
too irregular to measure.

B

 

 

 

Question 42

Knowledge of the culture or cultures represented by the patient should be used to:

help make the interview questions more pertinent.
draw conclusions regarding individual patient needs.
form stereotypical categories.
form a sense of the patient.

A

 

 

 

The review of systems is a component of the:

health history.
assessment.
physical examination.
past medical/surgical history.

A

 

 

 

 

 

Question 44

Mr. Akins is a 78-year-old patient who presents to the clinic with complaints of hearing loss. Which of the following are changes in hearing that occur in the elderly? Select all that apply.

a. Progression is slow
b. Bone conduction heard longer than air conduction
c. Results from cranial nerve VII
d. Loss of high frequency
e. Sounds may be garbled and difficult to localize
f. Unable to hear in a crowded room

D

E

F

 

 

 

Question 45

Which of the following is an expected change in the assessment of the thyroid during pregnancy?

A bruit is auscultated.
Inspection reveals a goiter.
The gland is tender upon palpation.
Palpation of the gland becomes difficult.

A

 

 

Question 46

A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she:

is cold intolerant.
binges and vomits.
has constipation frequently.
has regular menstrual periods.

Bb

 

 

 

Question 47

Mr. Walters, a 32-year-old patient, tells you that his ears are “stopped up.” An objective assessment of this complaint is achieved by using the:

otoscope with pneumatic attachment.
tympanometer.
reflex hammer.
tuning fork.

B

 

 

Question 48

During an interview, you have the impression that a patient may be considering suicide. Which action is essential?

Ask whether the patient has considered self-harm.
Avoid directly confronting the patient regarding your impression.
Record the impression in the patient’s chart and refer the patient for hospitalization.
Ask whether the patient would like to visit a psychiatrist.

A

 

 

 

Question 49

When are open-ended questions generally most useful?

During the initial part of the interview
While designing the genogram
During the review of systems
After several close-ended questions have been asked

A

 

 

 

 

Question 50

When assessing abdominal pain in a college-age woman, one must include:

history of interstate travel.
food likes and dislikes.
the first day of the last menstrual period.
age at completion of toilet training.

C

 

 

Question 51

Regardless of the origin, discharge is described by noting:

color and consistency.
associated symptoms in alphabetic order.
a grading scale of 0 to 4.
demographic data and risk factors.

A

 

 

 

Question 52

Spasmodic muscular contractions of the head, face, or neck are called:

D. webbing.
B. tics.
A. torticollis.
C. dimpling.

B

 

 

 

Question 53

Before performing an abdominal examination, the examiner should:

don double gloves.
have the patient empty his or her bladder.
ascertain the patient’s HIV status.
completely disrobe the patient.

B

 

 

 

 

Question 54

The recommended minimum daily protein requirement for the normal adult is ______

14-20%

 

 

Question 55

Subjective and symptomatic data are:

not mentioned in the legal chart.
recorded with the examination technique.
placed in the history section.
documented with the examination findings.

C

 

 

Question 56

Your patient returns for a blood pressure check 2 weeks after a visit during which you performed a complete history and physical. This visit would be documented by creating a(n):

accident report.
progress note.
triage note.
problem-oriented medical record.

B

 

 

 

Question 57

Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?

Progress note
Brief SOAP note
Referral note
Comprehensive health history

B

 

 

 

Question 58

You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be:

ignored while you address all questions to the parent.
mailed a questionnaire in advance to avoid the need for her to talk.
given the opportunity to be interviewed without the parent at some point during the interview.
allowed to direct the flow of the interview.

C

 

 

 

 

 

Question 59

A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:

use topical over-the-counter hemorrhoid treatment for 1 week.
eat six small meals a day.
exercise and eat more fiber.
come to the laboratory for a stool guaiac test.

D

 

 

Question 60

Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem?

“What are your age, race, and educational level?”
“What types of symptoms have you been having?”
“Why do you think you are having these symptoms?”
“How often do you have medical examinations?”

C

 

 

 

 

Question 61

Which cranial nerves innervate the face?

A. II and V
B. III and VI
D. VIII and IX
C. V and VII

D

 

 

Question 62

Peritonitis produces bowel sounds that are:

absent.
high pitched.
hypoactive.
hyperactive.

C

 

 

 

 

 

Question 63

Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her current weight. In your patient teaching with her, you explain the importance of macronutrients. Which of the following is a macronutrient?

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Fat
Calcium
Iron
Thiamin

A

 

 

Question 64

Nasal symptoms that imply an allergic response include:

small, atrophied nasal membranes.
firm consistency of turbinates.
purulent nasal drainage.
bluish gray turbinates.

D

 

 

Question 65

Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a:

D. thyroglossal duct cyst.
A. parotid gland tumor.
B. branchial cleft cyst.
C. Stensen duct stone.

A

 

 

Question 66

Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish:

C. sebaceous hyperplasia from eczema.
D. seborrheic keratoses from actinic keratoses.
B. furuncles from folliculitis.
A. cutaneous tags from lentigines.

B

 

Question 67

When you are questioning a patient regarding alcohol intake, she tells you that she is only a social drinker. Which initial response is appropriate?

“I’m glad that you are a responsible drinker.”
“If you only drink socially, you won t need to worry about always having a designated driver.”
“Do the other people in your household consume alcohol?”
“What amount and what kind of alcohol do you drink in a week?”

D

 

Question 68

Mrs. Kinder is a 39-year-old patient who presents to the office with complaints of an earache. In explaining to the patient about the function of her ears, which ear structure would you tell her is responsible for equalizing atmospheric pressure when swallowing, sneezing, or yawning?

Eustachian tube
Triangular fossa
Inner ear
Pars flaccida

A

 

 

Question 69

What finding is unique to the documentation of a physical examination of an infant?

Thyroid position
Prostate size
Liver span
Fontanel sizes

D

 

 

Question 70

A blood pressure cuff bladder should be long enough to:

cover 75% to 80% of the arm circumference.
completely encircle the arm.
cover 20% to 25% of the arm circumference.
cover 45% to 50% of the arm circumference.

D

 

 

Question 71

Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to:

hold the speculum in the canal.
pull the auricle down and back.
distract the infant.
stabilize the chest.

B

 

 

Question 72

To perform the Rinne test, place the tuning fork on the:

preauricular area.
mastoid bone.
top of the head.
forehead.

B

 

Question 73

Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence?

C. Mandible and maxilla bones
B. Hyoid and cricoid cartilages
D. Nose and thyroid cartilages
A. Coronal sutures

C

 

 

 

 

Question 74

Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the skin is best conducted:

B. under fluorescent lighting.
D. using a Wood’s light.
C. with illumination provided by daylight.
A. using an episcope.

C

 

Question 75

Mr. Kevin Marks is a new health care provider. What is the best method to develop cultural competence?

Realize that all members of a cultural group behave in the same way.
Ignore one’s own cultural beliefs.
Realize that cultural values are difficult to change and must be respected.
Attempt to convince the patient to accept institutional mores.

C

 

 

 

Question 76

Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis would be:

extremely obese.
overweight.
obese.
normal body weight.

C

 

Question 77

The most common form of birth trauma of the scalp is:

cranial bossing.
torticollis.
caput succedaneum.
cephalhematoma.

C

 

 

Question 78

Mr. L. presents to the clinic with severe groin pain and a history of kidney stones. Mr. L.’s son tells you that, for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response?

“The stone must be sent to the lab for examination and therefore cannot be kept.”
“We don’t know yet if your father has another kidney stone, so we must analyze this one.”
“With your father’s permission, we will examine the stone and request that it be returned to him.”
“We cannot let him keep his stone because it violates our infection control policy.”

C

 

 

Question 79

Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to:

inspect for ecchymosis of the flank.
auscultate for abdominal bruits.
assess for rebound tenderness.
percuss for ascites.

A

 

Question 80

Mr. Black is a 44-year-old patient who presents to the clinic with complaints of neck pain that he thinks is from his job involving computer data entry. As the examiner, you are checking the range of motion in his neck and note the greatest degree of cervical mobility is at:

B. C2 to C3.
D. C4 to C5.
A. C1 to C2.
C. C3 to C4.

B

 

 

stion 81

Which of the following organs is part of the alimentary tract?

Gallbladder
Pancreas
Stomach
Liver

C

 

uestion 82

You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient:

sit upright.
hold his or her breath.
flex his or her knees.
raise his or her head off the pillow.

C

 

estion 83

Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal pain. You have completed the inspection of the abdomen. What is your next step in the assessment process?

Deep palpation
Auscultation
Percussion
Light palpation

B

Question 84

Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test for:

lateralization of sound.
air conduction of sound.
bone versus air conduction.
mallear auditory ability.

A

 

 

uestion 85

Before performing an abdominal examination, the examiner should:

have the patient empty his or her bladder.
completely disrobe the patient.
don double gloves.
ascertain the patient’s HIV status.

C

 

George Michaels, a 22-year-old patient, tells the nurse that he is here today to “check his allergies.” He has been having “green nasal discharge” for the last 72 hours. How would the nurse document his reason for seeking care?

G. M. is a 22-year-old male here for “allergies.”
G. M. came into the clinic complaining of green discharge for the past 72 hours.
G. M., a 22-year-old male, states he has allergies and wants them checked.
G.M. is a 22-year-old male here for having “green nasal discharge” for the past 72 hours.

D

 

Question 87

Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?

Rebound tenderness
Consistent right lower quadrant (RLQ pain)
Positive McBurney sign
Positive psoas sign

A

 

Question 88

Bulging of an amber tympanic membrane without mobility is most often associated with:

repeated and prolonged crying cycles.
middle ear effusion.
healed tympanic membrane perforation.
impacted cerumen in the canal.

B

 

 

Question 89

Recommended carbohydrate content of total dietary intake (% total calories) is ____%.

50

 

uestion 90

Unusual white areas on the skin may be due to:

B. polycythemia.
A. adrenal disease.
D. Down syndrome.
C. vitiligo.

D

 

uestion 91

Auscultation should be carried out last, except when examining the:

lungs.
abdomen.
heart.
neck area.

Bb

 

Question 92

Penicillin is considered a

“cold” medicine.
“hot” medicine.
“lukewarm” oil.
“cold” herb.

Bbb

 

 

uestion 93

In examining the neck of a 34-year-old female patient, you note that the uppermost ridge of the tracheal cartilage is at the: NURS 6512 Advanced Health Assessment midterm exam questions and answers

sternocleidomastoid.
thyroid.
hyoid.
cricoid.

D

 

 

 

Question 94

When assessing abdominal pain in a college-age woman, one must include:

age at completion of toilet training.
the first day of the last menstrual period.
history of interstate travel.
food likes and dislikes.

B

 

 

Question 95

A detailed description of the symptoms related to the chief complaint is presented in the:

general patient information section.
differential diagnosis.
assessment.
history of present illness.

D

 

Question 96

Periods of silence during the interview can serve important purposes, such as:

providing time for reflection.
increasing the length of the visit.
promoting calmness.
allowing the clinician to catch up on documentation.

D

 

 

Question 97

A guideline for history taking is for caregivers to:

ask direct questions before open-ended questions so that data move from simple to complex.
ask for a complete history at once so that data are not forgotten between meetings.
make notes sparingly so that patients can be observed during the history taking.
write detailed information as stated by patients so that their priorities are reflected.

C

 

Question 98

Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure:

hearing range of normal speech.
buzzing or tingling sensations.
noise above the threshold level.
buzzing from bone conduction.

A

 

 

Question 99

Which is the best way to position a patient’s neck for palpation of the thyroid?

B. Flexed directly forward
C. Flexed toward the side being examined
A. Flexed away from the side being examined
D. Hyperextended directly backward

B

 

 

Question 100

Which question would be considered a leading question?

“You don’t get headaches often, do you?”
“At what time of the day are your headaches the most severe?”
“On a scale of 1 to 10, how would you rate the severity of your headaches?”
“What do you think is causing your headaches?”

A

NURS 6501 Advanced Pathophysiology Module

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NURS 6501 Advanced Pathophysiology Module

  • Question 1

Needs Grading

A 67-year-old Caucasian woman was brought to the clinic by her son who stated that his mother had become slightly confused over the past several days. She had been stumbling at home and had fallen once but was able to ambulate with some difficulty. She had no other obvious problems and had been eating and drinking. The son became concerned when she forgot her son’s name, so he thought he better bring her to the clinic.

PMH-Type II diabetes mellitus (DM) with peripheral neuropathy x 20 years. COPD. Depression after death of spouse several months ago

Social/family hx – non contributary except for 30 pack/year history tobacco use.

Meds: Metformin 500 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago

Labs-CBC WNL; Chem 7- Glucose-92 mg/dl, BUN 18 mg/dl, Creatinine 1.1 mg/dl, Na+120 mmol/L,

K+4.2 mmol/L, CO237 m mol/L, Cl–97 mmol/L.

The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH). NURS 6501 Advanced Pathophysiology Module

 

Question:

Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH.

 
Correct Answer:  

SIADH is a group of symptoms that occurs when antidiuretic hormone (ADH, arginine vasopressin) is secreted in the absence of osmotic or physiologic stimuli. These stimuli include: Increased serum osmolality, decreased plasma volume, and hypotension. A decrease in plasma osmolality normally inhibits ADH production and secretion. SIADH is characterized by fluid retention, dilutional hyponatremia, hypochloremia, concentrated urine, and lack of intravascular volume depletion. SIADH is characterized by normal to increased blood volume in normoproteinemia, nonedematous, and hyponatremic patients with normal renal and endocrine function. ADH regulates the body’s water balance. It is synthesized in the hypothalamus and stored in the posterior pituitary gland. When released into the circulation, it acts on the kidney’s distal tubules and collecting ducts, increasing their permeability to water. This decreases urine volume because more water is being reabsorbed and returned to the circulation. It also serves to produce more concentrated urine.
  • Question 2

Needs Grading

A 43-year-old female presents to the clinic with a chief complaint of fever, chills, nausea and vomiting and weakness. She has been unable to keep any food, liquids or medications down. The symptoms began 3 days ago and have not responded to ibuprofen, acetaminophen, or Nyquil when she tried to take them. The temperature has reached as high as 102˚F.

 

Allergies: none known to drugs or food or environmental

 

Medications-20 mg prednisone po qd, omeprazole 10 po qam

 

PMH-significant for 20-year history of steroid dependent rheumatoid arthritis (RA). GERD. No other significant illnesses or surgeries.

 

Social-denies alcohol, illicit drugs, vaping, tobacco use

 

Physical exam

 

Thin, ill appearing woman who is sitting in exam room chair as she said she was too weak to climb on the exam table. VS Temp 101.2˚F, BP 98/64, pulse 110, Resp 16, PaO2 96% on room air.

 

ROS negative other than GI symptoms.

 

Based on the patient’s clinical presentation, the APRN diagnoses the patient as having secondary hypocortisolism due to the lack of prednisone the patient was taking for her RA secondary to vomiting.

 

Question:

 

Explain why the patient exhibited these symptoms? 
Correct Answer:  

An adrenal insufficiency requires some type of trigger or stressor such as surgery, trauma, infection or acute withdrawal of glucocorticoids. The patient had several factors contributing to her present situation. She had RA x 20 years that necessitated oral prednisone. Increased levels of both glucocorticoids (primarily cortisol) and mineralocorticoids (primarily aldosterone) are needed for the body to adapt to the stress Corticotropin-releasing hormone (CRH) from the hypothalamus eventually prompts release of ACTH from the anterior pituitary gland. ACTH then stimulates release and 3 synthesis of cortisol from the adrenal cortex. Cortisol mobilizes amino acids from skeletal muscle and generally enhances the liver’s capacity for gluconeogenesis as well as enhances normal immune activity and maintenance of cardiovascular integrity. It also influences fat, carbohydrate and protein. Catecholamines cause vasoconstriction, which in the kidney, probably initiates release of renin, stimulating the rennin-angiotensionaldosterone-system (RAAS). Antidiuretic hormone (ADH, also called vasopressin), is released from the hypothalamus and posterior pituitary during periods of stress. Both aldosterone and ADH attempt to conserve water and electrolytes to sustain a sufficient vascular volume.
  • Question 3

Needs Grading

A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had about of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.

The APRN examining the patient orders a Chem 7 which revealed a serum Ca++ of 13.1 mg/dl. The APN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis.

Question:

What is the role of parathyroid hormone in the development of primary hyperparathyroidism? 
Correct Answer:  

Primary hyperparathyroidism is the unregulated overproduction of parathyroid hormone (PTH) resulting in abnormal calcium balance. PTH secretion is increased and is not under the usual feedback control mechanisms. The Ca++ level in the blood increase because of increased resorption and GI absorption of calcium but fails to inhibit PTH secretion at normal levels of calcium because the feedback threshold for calcium is set at a higher level in the abnormal parathyroid tissues. Hypercalcemia and hypophosphatemia are the clinical hallmarks of hyperparathyroidism.
  • Question 4

Needs Grading

A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.

 

The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis.

 

Question 1 of 2:

 

Explain the processes involved in the formation of renal stones in patients with hyperparathyroidism. 
Correct Answer:  

Increased renal filtration load of calcium leads to hypercalciuria. Hypercalcemia also affects proximal renal tubular functions, causing metabolic acidosis and production of abnormally alkaline urine. PTH hypersecretion enhances real phosphate excretion and results in hypophosphatemia and hyperphosphatemia. The combination of hypercalciuria, alkaline urine, and hyperphosphaturia leads to the formation of renal stones
  • Question 5

Needs Grading

A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.

The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis.

Question 2 of 2:

Explain how a patient with hyperparathyroidism is at risk for bone fractures.  
Correct Answer:  

Excessive osteoclastic and osteocytic activity results in increased bone reabsorption that weakens the bone. Kyphosis of the dorsal spine and compression fractures of the vertebral bodies are also seen in patients with hyperparathyroidism. NURS 6501 Advanced Pathophysiology Module
  • Question 6

Needs Grading

A 64-year-old Caucasian female who is 4 weeks status post total parathyroidectomy with forearm gland insertion presents to the general surgeon for her post-operative checkup. She states that her mouth feels numb and she feels “tingly all over. The surgeon suspects the patient has hypoparathyroidism secondary to the parathyroidectomy with delayed vascularization of the implanted gland. She orders a Chem 20 to determine what electrolyte abnormalities may be present. The labs reveal a serum Ca++ of 7.1 mg/dl (normal 8.5 mg/dl-10.5 mg/dl) and phosphorous level of 5.6 mg/dl (normal 2.4-4.1 mg/dl).

 

Question:

 

What serious consequences of hypoparathyroidism occur and why? 
Correct Answer:  

Hypoparathyroidism occurs when there is destruction of the parathyroid glands (autoimmune, surgical), abnormal parathyroid gland development, altered regulation of PTH production, or impaired PTH action. The acute manifestations of hypoparathyroidism (postsurgical hypoparathyroidism) are due to acute hypocalcemia.  The hallmark of acute hypocalcemia is tetany, which is a disorder of neuromuscular irritability. The symptoms of tetany may be mild (perioral numbness, paresthesia of the hands and feet, muscle cramps) or severe (carpopedal spasm, laryngospasm, and focal or generalized seizures, which must be distinguished from the generalized tonic muscle contractions that occur in severe tetany). The classic physical findings in patients with neuromuscular irritability due to latent tetany are Trousseau’s and Chvostek’s signs.
  • Question 7

Needs Grading

A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.

 

PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child

 

Allergies-none know

 

Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

 

Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.

 

Labs in office: random glucose 220 mg/dl.

 

Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.

 

Question 1 of 6:

 

The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polydipsia.”
Correct Answer:  

Because elevated blood glucose levels, water is osmotically attracted from body cells which results in intracellular dehydration and hypothalamic stimulation of thirst.
  • Question 8

Needs Grading

A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.

 

PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child

 

Allergies-none know

 

Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

 

Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.

 

Labs in office: random glucose 220 mg/dl.

 

Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.

Question 2 of 6:

 

The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyuria.”
Correct Answer:  

Hyperglycemia acts as an osmotic diuretic. The amount of glucose filtered by the glomeruli of the kidneys exceeds the amount that can be reabsorbed by the renal tubules. Glycosuria results accompanied by large amounts of water lost in the urine.
  • Question 9

Needs Grading

A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.

PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child

Allergies-none know

Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.

Labs in office: random glucose 220 mg/dl.

Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.

Question 3 of 6:

The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyphagia.”
Correct Answer:  

Depletion of cellular stores of carbohydrates, fats, and proteins results in cellular starvation and a corresponding increase in hunger.
  • Question 10

Needs Grading

A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.

 

PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child

 

Allergies-none know

 

Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

 

Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.

 

Labs in office: random glucose 220 mg/dl.

 

Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.

Question 4 of 6:

The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “weight loss.”
Correct Answer:  

Weight loss occurs because of fluid loss in osmotic diuresis and the loss of body tissue as fat and proteins are used for energy as a result of the effects of insulin deficiency.
  • Question 11

Needs Grading

A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.

PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child

Allergies-none know

Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.

Labs in office: random glucose 220 mg/dl.

Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.

Question 5 of 6:

The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “fatigue.”
Correct Answer:  

Metabolic change result in poor use of food products, contributing to lethargy and fatigue. Sleep loss from severe nocturia also contributes to fatigue.

Needs Grading

A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.

PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child

Allergies-none know

Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends.

Labs in office: random glucose 220 mg/dl.

Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.

Question 6 of 6:

How do genetics and environmental factors contribute to the development of Type 1 diabetes?
Correct Answer:  

Islet cell autoantibodies (ICAs) were detected in serum from patients with autoimmune polyendocrine deficiency. They have subsequently been identified in 85 percent of patients with newly diagnosed type 1 diabetes and in prediabetic people.

Autoantigens form on insulin producing beta cells and circulate in the blood and lymphatics. This leads to processing and presentation of autoantigen by antigen presenting cells

There is activation of T helper 1 lymphocytes and T helper 2 lymphocytes There is activation of macrophages that release IL-1 and TNFα and activation of autoantigen specific T cytotoxic CD8 cells. NURS 6501 Advanced Pathophysiology Module

There is activation of B lymphocytes to produce islet cell autoantibodies and antiGAD65 antibodies. This cascade results in destruction of beta cells with decreased insulin production.
  • Question 13

Needs Grading

A 17-year-old boy recently diagnosed with Type I diabetes is brought to the pediatrician’s office by his parents with a chief complaint of “having the flu”. His symptoms began 2 days ago, and he has vomited several times and has not eaten very much. He can’t remember if he took his prescribed insulin for several days because he felt so sick. Random glucose in the office reveals glucose 560 mg/dl and the pediatrician made arrangements for the patient to be admitted to the hospitalist service with an endocrinology consult.

 

BP 124/80mmHg; HR 122bpm; Respirations 32 breaths/min; Temp 97.2˚F; PaO297% on RA

 

Admission labs: Hgb 14.6 g/dl; Hct 58%

 

CMP- Na+ 122mmol/L; K+ 5.3mmol/L; Glucose 560mg/dl; BUN 52mg/dl; Creatinine 4.9mg/dl;

 

Cl- 95mmol/L; Ca++ 8.8mmol/L; AST (SGOT) 248U/L; ALT 198U/L; CK 34/35 IU/L; Cholesterol 198mg/dl;

 

Phosphorus 6.8mg/dl; Acetone Moderate; LDH38U/L; Alkaline Phosphatase 132U/L.

 

Arterial blood gas values were as follows: pH 7.09; Paco220mm Hg; Po2100mm Hg; Sao2 98% (room air)

 

HCO3-7.5mmol/L; anion gap 19.4

 

A diagnosis of diabetic ketoacidosis was made, and the patient was transferred to the Intensive Care Unit (ICU) for close monitoring.

 

Question:

 

The hormones involved in intermediary metabolism, exclusive of insulin, that can participate in the development of diabetic ketoacidosis (DKA) are epinephrine, glucagon, cortisol, growth hormone. Describe how they participate in the development of DKA.
Correct Answer:  

The most important concept is that DKA is caused by insulin deficiency and an increase in counterregulatory hormones that include glucagon, catecholamines, cortisol, and growth hormone. These counter regulatory hormones normally antagonize insulin buy increasing glucose production and decreasing tissue use of glucose. Insulin deficiency results in decreased glucose uptake, increased fat mobilization with release of fatty acids and accelerated gluconeogenesis, glycogenesis, and ketogenesis. In the absence of insulin, the release of free fatty acids from adipocytes increases production of ketone bodies by the mitochondria of the liver that exceeds peripheral use. Accumulation of ketone bodies causes a drop in pH and triggers the buffering system associated with metabolic acidosis. Hyperketonemia may result from impaired use of ketones by peripheral tissue, which permits strong organic acids to circulate freely. Bicarbonate buffering then does not occur and the individual develops a metabolic acidosis.
  • Question 14

Needs Grading

A 67-year-old African American male presents to the clinic with a chief complaint that he has to “go to the bathroom all the time and I feel really weak.” He states that this has been going on for about 3 days but couldn’t come to the clinic sooner as he went to the Wound Care clinic for a dressing change to his right great toe that has been chronically infected, and he now has osteomyelitis. Patient with known Type II diabetes with poor control. His last HgA1C was 10.2 %. He says he can’t afford the insulin he was prescribed and only takes half of the oral agent he was prescribed. Random glucose in the office revealed glucose of 890 mg/dl. He was immediately referred to the ED by the APRN for evaluation of suspected hyperosmolar hyperglycemic non ketotic syndrome (HHNKS). Also called hyperglycemic hyperosmolar state (HHS).

 

Question:

 

Explain the underlying processes that lead to HHNKS or HHS.
Correct Answer:  

HHNKS differs from DKA in the degree of insulin deficiency (more profound I DKA) and the elevation of glucose levels and degree of fluid deficiency which are more marked in HHKS.

The basic underlying mechanism of HHS is a relative reduction in effective circulating insulin with a concomitant rise in counterregulatory hormones. Unlike patients with DKA, most patients with HHS do not develop significant ketoacidosis. Insulin remains available in amounts sufficient to inhibit lipolysis and ketogenesis but insufficient to prevent hyperglycemia. Hyperosmolarity itself may also decrease lipolysis, limiting the amount of free fatty acids available for ketogenesis.

Patients with HHS have a very high serum glucose concentration, a near normal serum bicarbonate level and pH, a serum osmolarity that is usually greater than 320 mOsm/L (normal 275–295 mOsm/L), and either absent or low levels of ketones in both the urine and serum. Electrolyte imbalances are common, with severe potassium deficits that need to be corrected, usually over several days. Phosphorous and sodium replacement may also be needed.
  • Question 15

Needs Grading

A 32-year-old woman presented to the clinic complaining of weight gain, swelling in her legs and ankles and a puffy face. She also recently developed hypertension and diabetes type 2. She noted poor short-term memory, irritability, excess hair growth (women), red-ruddy face, extra fat around her neck, fatigue, poor concentration, and menstrual irregularity in addition to muscle weakness. Given her physical appearance and history, a tentative diagnosis of hypercortical function was made. Diagnostics included serum and urinary cortisol and serum adrenocorticotropic hormone (ACTH). MRI revealed a pituitary adenoma.

 

Question:

 

How would you differentiate Cushing’s disease from Cushing’s syndrome? 
Correct Answer:  

Cushing’s syndrome is a rare disease that is caused by the over production of cortisol by the adrenal glands. This can be caused by a tumor of the adrenal glands, the lungs, or the pituitary gland. When the tumor produces too much ACTH, it causes over production of cortisol by the adrenal glands. If the source is the pituitary, it is called Cushing’s disease. Cushing’s disease occurs more often in women than men and more often occurs between the ages of 20 and 40.

ACTH dependent hypercortisolism, the excess ACTH stimulates excess production of cortisol and loss of the negative feedback control of ACTH secretion. People with Cushing’s syndrome do not have diurnal or circadian secretion patterns of ACTH and cortisol, and they do not increase ACTH and cortisol secretion in response to stressors.
  • Question 16

Needs Grading

A 47-year-old female is referred to the endocrinologist for evaluation of her chronically elevated blood pressure, hypokalemia, and hypervolemia. The patient’s hypertension has been refractory to the usual medications such as beta blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors. After a full work up including serum and urinary electrolyte levels, aldosterone suppression test, plasma aldosterone to renin ratio, and MRI which revealed an autonomous adenoma, the endocrinologist diagnoses the patient with primary hyper-aldosteronism.

 

Question:

 

What is the pathogenesis of primary hyper-aldosteronism? 
Correct Answer:  

Primary hyperaldosteronism can be caused by either hyperactivity in one adrenal gland (unilateral disease) or both (bilateral disease). Unilateral disease is usually caused by an aldosterone producing adenoma (benign tumor) and less commonly by adrenal cancer or hyperplasia (when the whole gland is hyperactive). Excessive autonomous secretion of aldosterone without its principle regulator, angiotension II, causes hypokalemia and induces insulin resistance; promotes inflammation, endothelial dysfunction, and cardiovascular remodeling (increased left ventricular wall and carotid intima thickness. It also affects adipose tissue differentiation and function. Therefore, primary hyperaldosteronism can influence the features of metabolic syndrome, including hypertension, obesity, dyslipidemia, insulin resistance and hyperglycemia.
  • Question 17

Needs Grading

A 47-year-old African American male presents to the clinic with chief complaints of polyuria, polydipsia, polyphagia, and weight loss. He also said that his vison occasionally blurs and that his feet sometimes feel numb.  He has increased hunger despite weight loss and admits to feeling unusually tired. He also complains of “swelling” and enlargement of his abdomen.

 

Past Medical History (PMH) significant for HTN fairly well controlled with and ACE inhibitor; central obesity, and dyslipidemia treated with a statin, Review of systems negative except for chief complaint. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 290 mg/dl. The APRN diagnoses the patient with type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching.

 

Question:

 

What is the basic underlying pathophysiology of Type II DM? 
Correct Answer:  

There are very complex interactions that result in the development of Type II diabetes. The pathophysiology of type 2 diabetes mellitus is characterized by peripheral insulin resistance, impaired regulation of hepatic glucose production, and declining β-cell function, eventually leading toβ -cell failure. Type 2 diabetes mellitus consists of a constellation of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. It is often associated with obesity.
  • Question 18

Needs Grading

A 21-year-old male was involved in a motorcycle accident and sustained a closed head injury. He is waking up and interacting with his family and medical team. He complained of thirst that doesn’t seem to go away no matter how much water he drinks. The nurses note that he has had 3500 cc of pale-yellow urine in the last 24 hours. Urine was sent for osmolality which was reported as 122 mOsm/L. A diagnosis of probable neurogenic diabetes insipidus was made.

 

Question:

 

What causes diabetes insipidus (DI)? 
Correct Answer:  

Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). There are 2 major forms: Central (neurogenic, pituitary, or neurohypophyseal) DI, characterized by decreased secretion of antidiuretic hormone (ADH; also referred to as arginine vasopressin [AVP]). Nephrogenic DI characterized by decreased ability to concentrate urine because of resistance to ADH action in the kidney.

AVP is the primary determinant of free water excretion in the body. Its main target is the kidney, where it acts by altering the water permeability of the cortical and medullary collecting tubules. Water is reabsorbed by osmotic equilibration with the hypertonic interstitium and returned to the systemic circulation. NURS 6501 Advanced Pathophysiology Module
  • Question 19

Needs Grading

A 43-year-old female patient presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and palpitations. She states she had had the symptoms for several months but attributed the symptoms to beginning to care for her elderly mother who has Alzheimer’s Disease. She has lost 15 pounds in the last 3 months without dieting. Her past medical history is significant for rheumatoid arthritis that she has had for the last 10 years well controlled with methotrexate and prednisone. Physical exam is remarkable for periorbital edema, warm silky feeling skin, and palpable thyroid nodules in both lobes of the thyroid. Pending laboratory diagnostics, the APRN diagnoses the patient as having hyperthyroidism, also called Graves’ Disease.

 

Question:

 

Explain how the negative feedback loop controls thyroid levels.
Correct Answer:  

Hyperthyroidism is a set of disorders that involve excessive synthesis and secretion of thyroid hormones T3 and T4. This unregulated release causes a hypermetabolic state that can lead to a serious condition called thyrotoxicosis. The thyroid gland is regulated by thyroid stimulating hormone (TSH) from the pituitary gland, which, in turn, is regulated by the hypothalamus via a negative feedback loop. Calcitonin, a hormone that affects blood calcium levels, is also secreted by the thyroid gland. Hyperthyroidism is known as Graves’ Disease. Genetic factors interacting with the environment triggers play an important role in the pathogenesis. It is classified as an autoimmune disease and often goes along with other autoimmune diseases. It results  from a failure of the feedback system. Normally, the secretion of thyroid hormone is controlled by a complex feedback mechanism involving the interaction of stimulatory and inhibitory factors (see the image below). Thyrotropin-releasing hormone (TRH) from the hypothalamus stimulates the pituitary to release TSH. In Graves’ disease, a circulating autoantibody against the thyrotropin receptor provides continuous stimulation of the thyroid gland. This stimulatory immunoglobulin has been called long-acting thyroid stimulator (LATS), thyroid-stimulating immunoglobulin (TSI), thyroid-stimulating antibody (TSab), and TSH-receptor antibody (TRab). These antibodies stimulate the production and release of thyroid hormones and thyroglobulin.
  • Question 20

Needs Grading

A 43-year-old female patient with known Graves’ Disease presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and severe palpitations. She states she had been given a prescription for propylthiouracil, an antithyroid medication but she did not fill the prescription as she claims she lost it. She had been given the option of thyroidectomy which she declined. She also notes that she is having trouble with her vision and often has blurry eyes. She states that her eyes seem “to bug out of her face”. She has had recurrent outs of nausea and vomiting. She was recently hospitalized for pneumonia.  Physical exam is significant for obvious exophthalmos and pretibial myxedema. Vital signs are temp 101.2˚F, HR 138 and irregular, BP 160/60 mmHg. Respirations 24. Electrocardiogram revealed atrial fibrillation with rapid ventricular response. The APRN recognizes the patient is experiencing symptoms of thyrotoxic crisis, also called thyroid storm. The patient was immediately transported to a hospital for critical care management.

 

Question:

 

How did the patient develop thyroid storm? What were the patient factors that lead to the development of thyroid storm? 
Correct Answer:  

Thyroid storm is a hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis. Individuals may be undiagnosed or undertreated when they develop the symptoms. The symptoms are caused by the sudden release and action of thyroxine (T4) and triiodothyronine (T3) that exceeds metabolic demands. Symptoms must be rapidly treated in order to prevent life threatening complications such as high output heart failure, hyperthermia, delirium and hypovolemia from excessive vomiting.
  • Question 21

Needs Grading

A 44-year-old woman presents to the clinic with complaints of extreme fatigue, weight gain, decreased appetite, cold intolerance, dry skin, hair loss, and sleepiness. She also admits that she often bursts into tears without any reason and has been exceptionally forgetful. Her vision is occasionally blurry, and she admits to being depressed without any social or occupational triggers. Past medical history noncontributory. Physical exam Temp 96.2˚F, pulse 62 and regular, BP 108/90, respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted. Based on the clinical history and physical exam, and pending laboratory data, the ARNP diagnoses the patient with hypothyroidism.

 

Question:

 

What causes hypothyroidism? 
Correct Answer:  

Patients with primary hypothyroidism have elevated TSH levels and decreased free hormone levels. Patients with elevated TSH levels (usually 4.5- 10.0 mIU/L) but normal free hormone levels or estimates are considered to have mild or subclinical hypothyroidism. The most common cause of hypothyroidism is autoimmune thyroiditis known as Hashimoto’s disease. Primary hypothyroidism is essentially the only disease that is characterized by sustained rises in TSH levels. As the TSH level increases early in the disease, conversion of T4 to T3 increases, maintaining T3 levels. In early hypothyroidism, TSH levels are elevated, T4 levels are normal to low, and T3 levels are normal.
  • Question 22

Needs Grading

A 44-year-old woman is brought to the clinic by her husband who says his wife has had some mental status changes over the past few days. The patient had been previously diagnosed with hypothyroidism and had been placed on thyroid replacement therapy but had been lost to follow-up due to moving to another city for the husband’s work approximately 4 months ago. The patient states she lost the prescription bottle during the move and didn’t bother to have the prescription filled since she was feeling better. Physical exam revealed non-pitting, boggy edema around her eyes, hands and feet as well as the supraclavicular area. The APRN recognizes this patient had severe myxedema and referred the patient to the hospital for medical management.

 

Question:

 

What causes myxedema coma? 
Correct Answer:  

In a patient with underlying hypothyroidism, inciting factors responsible for developing myxedema coma are numerous and include infection, trauma, cold exposure, or medications such as sedatives and anesthetics. Although most individuals are not comatose, they are at risk for significant cardiovascular and pulmonary complications. Patients will exhibit severe hypothermia without shivering, hypoventilation, hypotension, hypoglycemia, lactic acidosis ad coma.
  • Question 23

Needs Grading

A 53-year-old woman presents to the primary care clinic with complaints of severe headaches, palpitations, high blood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis.

Question 1 of 2:

 

What is a pheochromocytoma and how does it cause the classic symptoms the patient presented with? 
Correct Answer:  

Pheochromocytoma is an endocrine tumor of the adrenal gland that continuously secretes catecholamines (epinephrine and norepinephrine) in an uncontrolled fashion. Hypertension results from increase peripheral vascular resistance and may be sustained or paroxysmal. Because of excessive catecholamine secretion, pheochromocytomas may precipitate life-threatening hypertension or cardiac arrhythmias. Hypermetabolism and sweating are related to chronic activation of sympathetic receptors in adipocytes, hepatocytes and other tissue. Glucose intolerance may happen because of catecholamine induced inhibition of insulin release by the pancreas.

Catecholamines produced by pheochromocytomas are metabolized within chromaffin cells. Norepinephrine is metabolized to normetanephrine and epinephrine is metabolized to metanephrine. Because this process occurs within the tumor, independently of catecholamine release, pheochromocytomas are best diagnosed by measurement of these metabolites rather than by measurement of the parent catecholamines.
  • Question 24

Needs Grading

A 53-year-old woman presents to the primary care clinic with complaints of severe headaches, palpitations, high blood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis.

Question 2 of 2:

What are the treatment goals for managing pheochromocytoma? 
Correct Answer:  

Preoperative blockade of hormonally functional pheochromocytoma and paraganglioma (PPGL) to prevent cardiovascular complications is recommended, along with preoperative medical treatment to normalize blood pressure and heart rate and a  high-sodium diet with fluid intake to prevent severe hypotension after removal of the tumor. Blood pressure, heart rate, and glucose levels should be monitored immediately after surgery.

Minimally invasive (e.g., laparoscopic) adrenalectomy should be performed for most adrenal pheochromocytomas, with open resection reserved for very large or invasive pheochromocytomas; open resection is suggested for paragangliomas, but laparoscopic resection is an option for smaller tumors; partial adrenalectomy is also an option for certain patients.

Surgical resection of the tumor is the treatment of choice for pheochromocytoma and usually results in cure of the hypertension. Careful preoperative management is required to control blood pressure, correct fluid volume, and prevent intraoperative hypertensive crises. NURS 6501 Advanced Pathophysiology Module