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Course Outcome (CO). 

This week’s graded discussion topic relates to the following Course Outcome (CO).

•CO7 Integrates the professional role of leader, teacher, communicator, and manager of care to plan cost-effective, quality healthcare to consumers in structured and unstructured settings. (PO 7)

 

There is much attention on federal health care policy and law. Health Bills: GovTrack.us provides a list of federal bills that are currently in process in Congressional Committees.

Go to https://www.govtrack.us/congress/bills/subjects/health/6130 (Links to an external site.)Links to an external site.

Choose a health-related federal bill of interest to you. Read through the bill and post a summary in your own words. Include the bill number and name.

•How might this bill impact professional nursing practice standards if passed? If not passed?

•How might the bill impact your own nursing practice?

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Health Promotion During Pregnancy

Discussion: Health Promotion During Pregnancy

When caring for pregnant women, it is important to care for the whole person. This means you not only manage the pregnancy and treat conditions, but you also promote healthy behaviors and good lifestyle choices. Through health promotion, you can help to ensure the safety of both the mother and the baby. Your role in health promotion is to identify health risks that might result in pregnancy complications, educate patients on these risks, and provide the necessary support to help patients mitigate these risks. In this Discussion, you examine implications of drug use, alcohol consumption, dietary habits, and environmental exposures during pregnancy, and you consider ways to educate pregnant women about such risks.

To prepare:  Due 10.10.17 by 12 noon

1. Review Chapter 2 of the Tharpe et al. text and the

2. Article from the Centers for Disease Control and Prevention in this week’s  Learning Resources:

3. Consider lifestyle changes that pregnant women must make in relation to smoking. Select one of these topics to be the focus of an educational media piece you would create for health promotion during pregnancy.

· 4. Think about the patient population that you treat within your practicum setting. Consider ways to educate these patients on health promotion as it relates to the topic you selected. Then, consider the types of educational pieces, such as posters, that might be most effective with your patient population.

Post a detailed description of the educational media piece you would create for health promotion during pregnancy. Explain why you selected the particular topic (SMOKING), as well as why you selected the type of media (POSTER),  and how and why it is suitable for your patient population.

Note: Attach the POSTER to your Discussion posting before the References.

DUE ON: OCT. 17.17 by 12 noon

APA FORMAT

ZERO PLGIARISM

1&1/2 PAGE only.

:earning Resource/Required Readings/References

Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.

  • Review Chapter 30, “Diagnosis of Pregnancy and      Overview of Prenatal Care” (pp. 781-797)

This chapter examines the diagnosis of pregnancy, routine prenatal care, and patient education strategies for pregnant women.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

  • Review: Chapter 2, “Care of the Woman During      Pregnancy” (pp. 49-90)

This chapter explores the care of women during pregnancy, including common health conditions and health promotion.

  • Chapter 3, “Care of the Pregnant Woman with      Prenatal Conditions” (pp. 93-154)

This chapter examines the care of women who suffer from complications during pregnancy and focuses on interventions that maximize health outcomes for the mother and baby.

Centers for Disease Control and Prevention. (2011). During pregnancy. Retrieved from http://www.cdc.gov/pregnancy/during.html

This website emphasizes the need for health promotion during pregnancy. Implications of smoking, alcohol, infections, and environmental exposures are explored.

Optional Resources

Centers for Disease Control and Prevention. (2012b). Women’s health. Retrieved from http://www.cdc.gov/women/

National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH). Retrieved from http://orwh.od.nih.gov/

U.S. Department of Health and Human Services. (2012a). Womenshealth.gov. Retrieved from http://www.womenshealth.gov/

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Emergency Response Planning 

Activity 6

Emergency Response Planning

Emergency response planning is the organization, coordination, and direction of available resources to respond to an event or bring and emergency under control.

Select one of the scenarios below and complete the activity.

Earthquake Emergency Response

The healthcare team has just been notified that there was an earthquake in the Sentinel Mountains that has destroyed buildings in Industrial Heights and Casper Park residential area of Sentinel City®.

  • Visit the Industrial Heights and Casper Park residential areas of Sentinel City® and consider the impact zone of an earthquake.  Observe the services, routes and populations that may be involved with the city as a result of the earthquake.
  • Create a report that describes the potential public health effects, infrastructure damage and environmental hazards related to the earthquake.  Describe the members and roles of the emergency management team and organizations (public and private) that would be activated in Sentinel City®.
  • Who are the members of the emergency response team that will be deployed? What private and public resources will assist with the response in the short and long term?
  • What are the risks and benefits of the quick public responses that will be shared on social media?

Tornado Emergency Response

The healthcare team has just been notified that there was a tornado that ripped through Casper Park and Acer Tech Center in Sentinel City®.

  • Visit the Casper Park and Acer Tech Center areas of Sentinel City® and consider the impact zone of the tornado.  Observe the services, routes and populations that may be involved with the city as a result of the tornado.
  • Create a report that describes the potential public health effects, infrastructure damage and environmental hazards related to the tornado.  Describe the members and roles of the emergency management team and organizations (public and private) that would be activated in Sentinel City®.
  • Who are the members of the emergency response team that will be deployed? What private and public resources will assist with the response in the short and long term?
  • What are the risks and benefits of the quick public responses that will be shared on social media?

Civic Disturbance Emergency Response

The healthcare team has just been notified that there is a civic disturbance at City Hall with injuries in Sentinel City®.

  • Visit the area City Hall.  Observe the services, routes and populations that may be involved with the city as a result of the civic disturbance.
  • Create a report that describes the potential public health effects and environmental hazards related to the civic disturbance.  Describe the members and roles of the emergency management team and organizations (public and private) that would be activated in Sentinel City®.
  • Who are the members of the emergency response team that will be deployed? What private and public resources will assist with the response in the short and long term?
  • What are the risks and benefits of the quick public responses that will be shared on social media?

Reading and Resources

Additional Instructions:

  1. All submissions should have a title page and reference page.
  2. Utilize a minimum of two scholarly resources.
  3. Adhere to grammar, spelling and punctuation criteria.
  4. Adhere to APA compliance guidelines.
  5. Adhere to the chosen Submission Option for Delivery of Activity guidelines.

Submission Option

  • 2 to 3-page paper. Include title and reference pages.

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    Critical Appraisal of Practice Guidelines 

    Critical Appraisal of Practice Guidelines 

While there are several tools to critically appraise practice guidelines, the most comprehensively validated appraisal tool is the AGREE II Instrument. The AGREE II Instrument can be used by individual practitioners to critically appraise health guidelines and by decision makers to inform policy decisions. The purpose of the AGREE II Instrument is to provide a framework to:

1. Assess the quality of guidelines.

2. Provide a methodological strategy for the development of guidelines.

3. Inform what information and how the information ought to be reported in guidelines.

Overall assessment includes rating the overall quality of the guideline and whether the guideline would be recommended for use in practice.
Items are rated on a 7-point scale from 1 (Strongly Disagree) to 7 (Strongly Agree). A score of 1 is given when there is no information on that item or if it is poorly reported. A score of 7 is given if the quality of reporting is excellent and when full criteria have been met (Score explanations found in the AGREE II-GRS Instrument).
A quality score is calculated for each of the six domains, which are independently scored. Domain scores are calculated by summing up all the scores of the items in the domain and by scaling the total as a percentage of the maximum possible score for that specific domain.

For this assignment, you will choose a guideline and assess the overall quality and whether the guideline would be recommended for use in practice.

General Requirements:

Use the following information to ensure successful completion of this assignment:

· Download the AGREE II instrument. http://www.agreetrust.org/wp-content/uploads/2013/10/AGREE-II-Users-Manual-and-23-item-Instrument_2009_UPDATE_2013.pdf

· Doctoral learners are required to use APA style for their writing assignments.

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

Directions:

Perform the following tasks to complete this assignment:

1. Using the AGREE II instrument as your guide, create a table that discusses a practice guideline in which you might have questioned the recommendations. (Note: You may be able to copy and paste the instrument into a new Word document and complete the information.)

2. Each domain must have its own cell (similar to the one shown in the manual) and add domain scores and an overall guideline assessment. Be sure to include comments and additional considerations that influenced your rating decision and cite any sources used.

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physician

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

 

After performing an emergency cesarean section, the physician noticed that the appendix was distended, resulting in medical necessity for an appendectomy performed during the same operative session.

2)      The physician freed intestinal adhesions.

3)      The physician resected two segments of small intestine and performed an anastomosis between the remaining intestinal ends. An open approach was used for this surgery.

4)      The physician repaired a defect in the mesentery with sutures.

5)      The physician performed a laparoscopic partial colectomy with end colostomy and closure of the distal segment.

6)      The physician drained a pelvic abscess through the rectum.

7)      The physician removed a portion of the rectum through combined abdominal and transsacral approaches.

8)      The physician performed rigid proctosigmoidoscopy and obtained brushings.

9)      The physician performed a flexible sigmoidoscopy and removed a polyp. The physician inserted the sigmoidoscope through the anus and advanced the scope into the sigmoid colon. The lumen of the sigmoid colon and rectum were well visualized, and the polyp was identified and removed with hot biopsy forceps. The sigmoidoscope was withdrawn upon completion of the procedure.

 

10)  The physician inserted a colonscope through the anus and advanced the scope past the splenic flexure. Two polps were identified and removed by hot biopsy forceps.

1)      Hepatotomy for open drainage of abscess or cyst, 1 stage.

2)      Surgeon removed segments II, III, and IV (the whole left lobe) of the liver from a living donor.

3)      The physician performed radiofrequency ablation of a liver tumor via open laparotomy.

4)      The physician removed the gallbladder and performed a common bile duct exploration through the laparoscope.

5)      The physician performed a cholecystostomy with removal of calculus.

6)      Subsequent to previous peritoneocentesis (performed at a different operative session), the physician withdrew fluid and performed infusion and drainage of fluid from the abdominal cavity (peritoneal lavage).

7)      The physician reopened a recent laparotomy incision, before the incision had fully healed, to drain a postoperative infection.

8)      The physician performed laparoscopic repair of an initial inguinal hernia.

9)      The physician performed a reducible ventral hernia (initial) repair and inserted mesh implantation.

 

10)  The physician repaired an initial reducible, inguinal hernia with hydrocelectomy in a 5 month old infant.

1)      Physician made an open incision and inserted multiple drain tubes to drain an infection (abscess) from the kidney.

2)      The physician pulverized a kidney stone (renal calculus) by directing shock waves through a water cushion that was placed against the left side of the patient’s body at the location of the kidney stone.

3)      The physician removed a kidney stone (calculus) by making an incision in the right kidney.

4)      The interventional radiologist inserted a percutaneous nephrostomy catheter into the right renal pelvis for drainage. Fluoroscopic guidance was provided.

5)      The physician performed a laparoscopic ablation of a solid mass from the posterior hilum of the left kidney.

6)      The physician made an incision in the left ureter through the abdominal wall for examination of the ureter and insertion of a catheter for drainage.

7)      The physician examined the patient’s right and left renal and ureteral structures with an endoscope, which passed through an established opening between the skin and the ureter (ureterostomy). He also inserted a catheter into the ureter.

8)      The physician revised a surgical opening between the skin and the right ureter.

9)      The physician injected contrast agent through an opening between the skin and the left ureter (ureterostomy) for ureterography (study of renal collecting system).

10)  The physician made an incision in the left ureter (ureterotomy) to insert a catheter (stent) into the ureter.

11)   The physician performed a transurethral resection of a postoperative bladder neck contracture using a resectoscope.

12)  The physician inserted a special instrument through the cystourethroscope to fragment a calculus in the ureter using electrohydraulics.

13)   The physician inserted a cystourethroscope through the urethra to drain an abscess on the prostate.

14)  The physician made an incision through the abdominal wall into the urinary bladder and inserted a suprapubic catheter to withdraw urine.

15)  The physician performed a cystourethroscopy with fulguration of the bladder neck and then removed a calculus from the ureter.

16)  The physician performed a sling procedure using synthetic material to treat a male patient’s urinary incontinence.

17)  The physician made an initial attempt to treat a male patient’s urethral stricture using a dilator.

18)  The physician, in the first two stages to reconstruct the urethra identified the area of stricture by urethrography and marked it with ink.

19)  The physician performed a transurethral destruction of the prostate using microwave therapy.

 

20)   The physician excised a specimen of tissue from the urethra for biopsy.

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moral awareness

Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.

Summarize the facts in a case study and use the 3 components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.

 

  • The ethical decision making-model:  moral awareness, moral judgement, and ethical behavior needs to be included in this paper
  •  apply more than 2 of the ethical principles: autonomy, and nonmaleficence.

 

  1. Length: At least 1 page typed, double-spaced pages, not including the title page and reference page.
  2. Font and font size: Times New Roman, 12 point.
  3. APA Template: Use the APA Style Paper Template as the paper format and the APA Style Paper Tutorial for guidance. See the Resources for these documents.
  4. Written communication: Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
  5. References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.
  6. APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page.

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hormone replacement therapy

In recent years, hormone replacement therapy has become a controversial issue. When prescribing therapies, advanced practice nurses must weigh the strengths and limitations of the prescribed supplemental hormones. If advanced practice nurses determine that the limitations outweigh the strengths, then they might suggest alternative treatment options such as herbs or other natural remedies, changes in diet, and increase in exercise.

Consider the following scenario:

  • As an advanced practice nurse at a community health clinic, you often treat female (and sometimes male patients) with hormone deficiencies. One of your patients requests that you prescribe supplemental hormones. This poses the questions: How will you determine what kind of treatment to suggest? What patient factors should you consider? Are supplemental hormones the best option for the patient, or would they benefit from alternative treatments?
To prepare:
  • Review Chapter 56 of the Arcangelo and Peterson text, as well as the Holloway and Makinen and Huhtaniemi articles in the Learning Resources.
  • Review the provided scenario and reflect on whether or not you would support hormone replacement therapy.
  • Locate and review additional articles about research on hormone replacement therapy for women and/or men. Consider the strengths and limitations of hormone replacement therapy.
  • Based on your research of the strengths and limitations, again reflect on whether or not you would support hormone replacement therapy.
  • Consider whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies.

With these thoughts in mind:

By Day 3

Post a description of the strengths and limitations of hormone replacement therapy. Based on these strengths and limitations, explain why you would or why you would not support hormone replacement therapy. Explain whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies and why.

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The Nurse as Advocate

The Nurse as Advocate

Whether nurses are advocating for their patients, health care, and/or policies that improve people’s lives, the advocacy processes have commonalities that transcend the subject of their advocacy. There are also differences, although these differences may be more nuanced than obvious.

Tasks:

Write a 5-page brief to answer the following questions. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources.Read the following chapters from your course textbook:(((SEE ATTACHED DOCUMENTS /CHAPTER 76-80)))))

  • Taking Action: Nurse, Educator, and Legislator: My Journey to the Delaware Senate
  • Taking Action: A Nurse in the Board Room

Answer the below questions:

  • Describe what you believe to be the drivers for each of the individuals? What factors led them to become advocates?
  • Discuss the challenges that each of them identified in their writings.
  • Analyze these drivers and challenges and compare them with your own experience to date as an advocate. In what ways do you believe that you can expand your advocacy skills within the next five years?

Submission Details:

  • Submit your response in a 5-page Microsoft Word document.
  • Cite sources in the APA format on a separate page.

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breast cance

Question

1. Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months. She has a positive family history of breast cancer. The primary care NP should recommend:

testosterone therapy.

estrogen-only therapy.

nonhormonal drugs for osteoporosis.

estrogen-progesterone therapy for 1 to 2 years.

Question 2. A patient takes a cardiac medication that has a very narrow therapeutic range. The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient’s medical plan. The NP knows that the bioavailability of the drug varies from brand to brand. The NP should:

contact the insurance provider to explain why this particular formulation is necessary.

change the patient’s medication to a different drug class that doesn’t have these bioavailability variations.

accept the situation and monitor the patient closely for drug effects with each prescription refill.

ask the pharmaceutical company that makes the drug for samples so that the patient does not incur out-of-pocket expense.

Question 3. A patient brings written information about a medication to a primary care NP about a new drug called Prism and wants to know if the NP will prescribe it. The NP notes that the information is from an internet site called “Prism.com.” The NP should tell this patient that:

this information is probably from a drug advertisement website.

this is factual, evidence-based material with accurate information.

the information is from a nonprofit group that will not profit from drug sales.

internet information is unreliable because anyone can post information there.

Question 4. A primary care NP is reviewing written information about a newly prescribed medication with a patient. To evaluate this patient’s understanding of the information, the NP should ask the patient to:

read the information aloud.

describe how the medication will be taken.

write down questions about the medication.

tell the NP if the information is unclear.

Question 5. A patient is diagnosed with lupus and reports occasional use of herbal supplements. The primary care NP should caution this patient to avoid:

ginseng.

echinacea.

ginkgo biloba.

St. John’s wort.

Question 6. A patient who has chronic pain and who takes oxycodone (Percodan) calls the clinic to ask for a refill of the medication. The primary care NP notes that the medication refill is not due for 2 weeks. The patient tells the NP that the refill is needed because he is going out of town. The NP should:

fill the prescription and document the patient’s explanation of the reason.

review the patient’s chart to see if this is a one-time or repeat occurrence.

call the patient’s pharmacist and report suspicion of drug-seeking behaviors.

confront the patient about misuse of narcotics and refuse to fill the prescription.

Question 7. The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners.Which statement by the patient indicates she understands the  regimen?

“I have to take a pill only every 3 months.

“I should expect to have only four periods each year.

“I will need to use condoms for only 7 more days.

“This type of pill has fewer side effects than other types.

Question 8. The primary care NP sees a patient covered by Medicaid, writes a prescription for a medication, and is informed by the pharmacist that the medication is “off-formulary.” The NP should:

inform the patient that an out-of-pocket expense will be necessary.

write the prescription for a generic drug if it meets the patient’s needs.

call the patient’s insurance provider to advocate for this particular drug.

contact the pharmaceutical company to see if medication samples are available.

Question 9. A 55-year-old woman has not had menstrual periods for 5 years and tells the primary care nurse practitioner (NP) that she is having increasingly frequent vasomotor symptoms. She has no family history or risk factors for coronary heart disease (CHD) or breast cancer but is concerned about these side effects of hormone therapy (HT). The NP should:

tell her that starting HT now may reduce her risk of breast cancer.

advise a short course of HT now that may decrease her risk for CHD.

tell her that HT will not help control her symptoms during postmenopause.

recommend herbal supplements for her symptoms to avoid HT side effects.

Question 10. A primary care NP recommends an over-the-counter medication for a patient who has acid reflux. When teaching the patient about this drug, the NP should tell the patient:

to take the dose recommended by the manufacturer.

not to worry about taking this drug with any other medications.

to avoid taking other drugs that cause sedation while taking this drug.

that over-the-counter acid reflux medications are generally safe to take with other medications.

Question 11. A patient will begin taking two drugs that are both protein-bound. The primary care NP should:

prescribe increased doses of both drugs.

monitor drug levels, actions, and side effects.

teach the patient to increase intake of protein.

stagger the doses of drugs to be given 1 hour apart.

Question 12. The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement. The child’s weight is 80% of what is recommended for age, and a recent swallow study revealed significant risk for aspiration. The child’s parents do not want the procedure. The NP should:

compromise with the parents and order a nasogastric tube for feedings.

initiate a discussion with the parents about the potential outcomes of each possible action.

refer the family to a case manager who can help guide the parents to the best decision.

understand that the child’s parents have a right to make choices that override those of the medical team.

Question 13. A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital. The NP should:

use an existing guideline from a leading research hospital.

follow the guideline provided by a third-party payer to help ensure reimbursement.

review expert opinion and experimental, anecdotal, correlational study data.

write the guideline to adhere to long-standing practice protocols already in use.

Question 14. The primary care nurse practitioner (NP) writes a prescription for an antibiotic using an electronic drug prescription system. The pharmacist will fill this prescription when:

the electronic prescription is received.

the patient brings a written copy of the prescription.

a copy of the written prescription is faxed to the pharmacy.

the pharmacist accesses the patient’s electronic record to verify.

Question 15. A primary care NP is preparing to prescribe a drug and notes that the drug has nonlinear kinetics. The NP should:

monitor frequently for desired and adverse effects.

administer a much higher initial dose as a loading dose.

monitor creatinine clearance at baseline and periodically.

administer the drug via a route that avoids the first-pass effect.

Question 16. An important difference between physician assistants (PAs) and NPs is PAs:

always work under physician supervision.

are not required to follow drug treatment protocols.

may write for all drug categories with physician co-signatures.

have both inpatient and outpatient independent prescriptive authority.

Question 17. A primary care NP writes a prescription for an off-label use for a drug. To help ensure compliance, the NP should:

include information about the off-label use on the E-script.

provide the patient with written instructions about how to use the medication.

tell the patient to let the pharmacist know that the drug is being used for an off-label use.

follow up by phone in several days to see if the patient is using the drug appropriately.

Question 18. A patient reports taking antioxidant supplements to help prevent cancer. The primary care NP should:

review healthy dietary practices with this patient.

make sure that the supplements contain large doses of vitamin A.

tell the patient that antioxidants are especially important for patients who smoke.

tell the patient that evidence shows antioxidants to be effective in preventing cancer.

Question 19. A woman comes to the clinic to talk about weight reduction. The primary care nurse practitioner (NP) calculates a body mass index (BMI) of 28. The woman’s waist measures 34 inches. The woman tells the NP that she would like to lose 20 lb for her daughter’s wedding in 6 months. The NP should:

suggest she try over-the-counter (OTC) orlistat.

consider prescribing phentermine short-term.

discuss her short-term and long-term weight loss goals.

give her information about physical activity and diet modification.

Question 20. A patient comes to the clinic and asks the primary care NP about using a newly developed formulation of the drug the patient has been taking for a year. When deciding whether or not to prescribe this formulation, the NP should:

tell the patient that when postmarketing data is available, it will be considered.

review the pharmaceutical company promotional materials about the new medication.

prescribe the medication if it is less expensive than the current drug formulation.

prescribe the medication if the new drug is available in an extended-release form.

Question 21. An adolescent girl has chosen Depo-Provera as a contraceptive method and tells the primary care NP that she likes the fact that she won’t have to deal with pills or periods. The primary care NP should tell her that she:

should consider another form of contraception after 1 year.

may have irregular bleeding, especially in the first month or so.

will need to take calcium and vitamin D every day while using this method.

will have to take oral contraceptive pills in addition to Depo-Provera when she takes antibiotics.

Question 22. A patient receives an inhaled corticosteroid to treat asthma. The patient asks the primary care NP why the drug is given by this route instead of orally. The NP should explain that the inhaled form:

is absorbed less quickly.

has reduced bioavailability.

has fewer systemic side effects.

provides dosing that is easier to regulate.

Question 23. A patient who has breast cancer has been taking toremifene for 2 weeks. She tells her primary care NP that she thinks her tumor has grown larger. The NP should:

schedule her for a breast ultrasound.

reassure her that this is common and will subside.

tell her she may need an increased dose of this medication.

contact her oncologist to discuss adding another medication.

Question 24. The primary care NP is prescribing a medication for an off-label use. To help prevent a medication error, the NP should:

write “off-label use” on the prescription and provide a rationale.

call the pharmacist to explain why the instructions deviate from common use.

write the alternative drug regimen on the prescription and send it to the pharmacy.

tell the patient to ignore the label directions and follow the verbal instructions given in the clinic.

Question 25. The primary care NP sees a woman who has been taking HT for menopausal symptoms for 3 years. The NP decreases the dosage, and several weeks later, the woman calls to report having several hot flashes each day. The NP should:

increase the HT dose.

discontinue HT.

recommend black cohosh to alleviate symptoms.

reassure her that these symptoms will diminish over time.

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lung cancer

Option #1 – Case Study to Consider

Ann and Michael have been married for 55 years. Ann is 80 years-old, and suffers from lung cancer and advanced Alzheimer’s disease. She currently resides in a nursing home, and often does not recognize Michael when he visits. Last night she was admitted to the hospital with difficulty breathing. Today, you are the nurse caring for Ann, and her physician is suggesting surgery to remove part of her lung to potentially slow the progression of her cancer. Michael is feeling unsure about this course of treatment, and asks for your advice and guidance.

How would you respond to Michael and serve as advocate for your patient?

Option #2 – Share a Related Experience

Share with your classmates a time when you cared for a patient at the end of their life. This may be a time when you assisted the patient (or their support system) with decisions related to end of life care; or a time when you were present for the death of a patient.

What were your observations related to this experience? Do you believe it was a peaceful death? What went well? Can you think of anything that could have made the experience better for the patient and/or family?

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