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eczema and allergies

NR 507 Week 1 Discussion:

PART 1

John is a 19-year-old college football player who presents with sneezing, itchy eyes, and nasal congestion that worsens at night. He states that he has a history of asthma, eczema and allergies to pollen. There is also one other person on the football team that has similar symptoms. His vitals are BP 110/70, P 84, R 18, T 100 F.

Write a differential of at least three (3) possible items from the most likely to less likely. For each disease include information about the epidemiology, pathophysiology and briefly argue why this disease fits the presentation and why it might not fit the presentation.

PART 2:

A patient has been admitted into the emergency room that was in the passenger side of a car that collided with another car head on. The patient is pale, barely conscious and has a weak and thready pulse. An IV is started. The vitals are BP 80/50, P 140, T 96.0 and R 26. As the team fights to keep the patient alive they have to remove the spleen. Blood is given but it has been mistyped. A transfusion reaction occurs.

Describe the type of hypersensitivity reaction that has occurred and discuss the molecular pathophysiology of the specific type of hypersensitive reaction you have chosen.

In the event that this patient survived the car accident and the transfusion reaction which organs are most likely to be damaged and why?

PART 3:

A 44-year-old patient presents with lump in the chest of approximately 2 cm in diameter. There is a slight dimple over the location of the lump and when the lump is manipulated it seems to be attached to the surrounding tissue. A lumpectomy is performed and the mass is sent to pathology. The pathology report comes back and the mass is confirmed to be an estrogen receptor negative, a progesterone receptor negative and a her2/neu receptor positive breast cancer.

• What are some of the risk factors for breast cancer?

• What tumor suppressor genes are associated with breast cancer?

• What tumor oncogenes are associated with breast cancer?

• Compare and contrast tumor suppressor genes from oncogenes?

NR 507 Week No. 1 Quiz:

1. Which statement about vaccines is true? (Points : 2)

2. Which statement is true about fungal infections? (Points : 2)

3. What is the role of reverse transcriptase in HIV infection? (Points : 2)

4. What of the following remains a significant cause of morbidity and mortality worldwide? (Points : 2)

5. Once they have penetrated the first line of defense, which microorganisms do neutrophils actively attack, engulf, and destroy by phagocytosis? (Points : 2)

6. After sexual transmission of HIV, a person can be infected yet seronegative for _____ months. (Points : 2)

7. Deficiencies in which element can produce depression of both B- and T-cell function? (Points : 2)

8. Hypersensitivity is best defined as a(n) (Points : 2)

9. A person with type O blood is likely to have high titers of anti-___ antibodies. (Points : 2)

10. What mechanism occurs in Raynaud phenomenon that classifies it as a type III hypersensitivity reaction? (Points : 2)

11. During an IgE-mediated hypersensitivity reaction, what causes bronchospasm? (Points : 2)

12. In a type II hypersensitivity reaction, when soluble antigens from infectious agents enter circulation, tissue damage is a result of (Points : 2)

13. In which primary immune deficiency is there a partial to complete absence of T-cell immunity? (Points : 2)

14. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? (Points : 2)

15. What effect does estrogen have on lymphocytes? (Points : 2)

16. Which hormone increases the formation of glucose from amino

17. During a stress response, increased anxiety, vigilance, and arousal is prompted by (Points : 2)

18. Which cytokine is involved in producing cachexia syndrome? (Points : 2)

19. Which of the viruses below are oncogenic DNA viruses? (Points : 2)

20. By what process does the ras gene convert from a proto-oncogene to an oncogene? (Points : 2)

21. What is the role of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor-alpha (TGF-) in cell metastasis? (Points : 2)

22. Many cancers create a mutation of ras. What is ras? (Points : 2)

23. In chronic myeloid leukemia (CML), a piece of chromosome 9 fuses to a piece of chromosome 22. This is an example of which mutation of normal genes to oncogenes? (Points : 2)

24. Tobacco smoking is associated with cancers of all of the following except (Points : 2)

25. What percentage of children with cancer can be cured? (Points : 2)

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informatics skills

How do the informatics skills you are now developing/expanding upon and validating help you meet current informatics skills levels? Did the TANIC self-assessment change your impression of your current informatics skill levels?

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PMHNP practice environment

Write a 2- to 3-page paper in which you do the following:

  • Describe      the PMHNP practice environment for your      home state, highlighting restrictions or limitations for      practice.
  • Compare      the PMHNP practice environment in your      home state with a neighboring state or a state in which you would like to practice ).
  • Describe      a professional and clinical practice      issue a new PMHNP will need to consider and address with the certification, licensure,      credentialing, or relocation process.
  • Develop      a checklist for passing the national certification exam, including a      detailed timeline that includes academic preparation (study plan),      registration, financial prepar*ation, etc.

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Christian vision,

Write a 1,500 word analysis of “Case Study: Healing and Autonomy.” In light of the readings, be sure to address the following questions:

  1. Under the Christian narrative and Christian vision, what sorts of issues are most pressing in this case study?
  2. Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful      to James?
  3. According to the Christian narrative and the discussion of the issues of treatment refusal, patient autonomy, and organ donation in the topic readings, how might one analyze this case?
  4. According to the topic readings and lecture, how ought the Christian think about sickness and health? What should Mike as a Christian do? How should he reason about trusting God and  treating James?

Prepare this assignment according to the guidelines found in the APA Style Guide.

NO PLAGIARISM PLEASE, MINIMUM OF 3 REFERENCES

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clinical judgment

Post a 3-5 sentence response to the below discussion question answer. Must have citations and with references in apa format:

“Evidence-based practice simply refers to combining research, clinical knowledge, and patient preferences to reach a health care decision – it emphasizes the use of the highest-quality information and deemphasizes the use of customs, opinions, or rituals to make a clinical judgment (DeCapua, 2019).” Because evidence-based practices encompass combining information from many different sources, including quality improvement and research, using the results from this would determine the best treatment for the patient. Because of this, providing care with EBP would be providing the patient with care that is safe, effective, and compassionate.

Nursing Managers, on the other hand, play a major role in a unit-based culture in which nursing practice is guided by evidence (Fisher & Sheeron, 2014). The role of the nurse manager is to encourage and support the clinical nurses working on the floor and develop a spirit of inquiry, seek answers to their clinical questions using EBP, and advance their clinical performance to improve patient outcomes (Caramanica & Spiva, 2018). This can be difficult as nurse managers still have to be able to perform their role responsibilities and attend to the demands of the unit while still supporting their nurses. Today, I believe that the role of the nurse manager in supporting evidence-based practice is under used and largely passive. If nurse managers were given the opportunity to support their clinical nursing staff as they were meant to be, I believe the results could be more fruitful, which would lead to nurses with stronger critical thinking skills and patients who receive high quality EBP patient care.

Original Question: How would a nurse practitioner and a nurse manager differ with regard to how they use and incorporate EBP in their areas of practice?

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differential diagnosis

APA format 3 peer references needs to review case study and document on differential diagnosis as to agreeing or disagreeing  Due October 20.2018 at 5pm

 

Episodic/Focused SOAP Note Template

Patient Information:

A.S., 46 F, Caucasain

S.

CC “ankle pain in both ankles; worse in right ankle, after hearing ‘pop’ while playing soccer.”

HPI: A.S. is a 46 year old Caucasian female who presents with bilateral ankle pain which she describes as chronic for the last 3 months. She acutely injured her right ankle 3 days ago while playing soccer. The pain is described as aching with intermittent sharp characteristics. Associated symptoms include limited ROM. The pain is worse with weight bearing and OTC pain medications have included alternating doses of Tylenol and Motrin with moderate relief.

Current Medications:

Motrin 200 mg by mouth every 4-6 hours as needed for pain

Hydrochlorothiazide 12.5mg by mouth daily for 6 months for HTN

Allergies: PCN- rash, no known food/environmental allergies

PMHx: HTN; immunizations are up to date- last tetanus 12/2017; flu shot 10/2018 cholecystectomy 2015

Soc Hx: A.S. is employed as a Registered Nurse and remains active by playing soccer three times a week. She is married with two teenage daughters. She denies tobacco and alcohol use.

Fam Hx: Maternal grandmother deceased at age 56 from MI. Maternal father deceased at age 75 from complications of COPD. Paternal grandparents unknown. Father history is unknown. Mother is alive with type 2 diabetes that is well controlled with oral agents. Sibling age 43 alive and well. Children are alive and well with no medical hx.

ROS:.

GENERAL:  No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema,

RESPIRATORY:  No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  No burning on urination.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: pain and swelling to right ankle, limited weight bearing and ROM in b/l ankles, worse in the right ankle. No muscle cramping.  No back pain.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis.

O.

GENERAL:  AAOx 3, limping gait, no distress. No fever.  Skin is warm, dry, and intact. Skin of the lower extremities is warm and pink in color.

CARDIOVASCULAR: chest is symmetric with symmetrical expansion, PMI noted at fifth intercostal space at the midclavicular line, normal S1 and S2, no m/r/g, no edema in legs, dorsalis pedis 2/4 bilaterally, normal hair distribution in legs and no pigmentation of b/l legs.

MUSCULOSKELETAL: limited ROM and weight bearing in b/l ankles, worse in right ankle. No clubbing, cyanosis, or edema.

NEUROLOGICAL: mood and affect appropriate, CN II-XII intact. Motor: 5/5 in upper and lower extremities, DTRs 2+ bilaterally.

Diagnostic results:

Ankle x-ray- If the Ottawa ankle rule is positive (bone tenderness at posterior malleolus, bone tenderness at posterior medial malleolus, or inability to bear weigh > 4 steps) ankle radiographs are indicated (Polzer, Kanz,  Prall, Haasters, Ockert, Mutschler, & Grote, 2012).

If ankle radiographs negative- assess ligament in affected extremity as compared to un-injured extremity by doing the crossed leg test, squeeze test, external rotation test, anterior drawer test, and talar tilt test. These tests will assist in determining the need for an MRI and also grading the sprain  (Polzer, Kanz,  Prall, Haasters, Ockert, Mutschler, & Grote, 2012).

Labs may include a uric acid level which is elevated with gout and a WBC which would be elevated with  osteomyelitis. MRI imaging may also be indicted.

A.

Sprain- because the patient heard the “pop” sound, her injury is likely related to an ankle sprain in which the ligaments and tissue that surround the bones of the ankle are injured causing swelling, pain, and limited ROM  (PubMed Health, 2018).

Fracture- a fracture would be unlikely if the patient was able to bear weight after the injury. The area would also become ecchymotic with limited to no ROM (PubMed Health, 2018).

Osteomyelitis- the extremity would be warm, erythematous, not usually associated with an acute injury, potential fever present, usually associated with a systemic infection or a wound (Ball, Dains, Flynn, Solomon, & Stewart, 2015)

Gout- associated with hot, swollen joints, pain and limited ROM (Ball, Dains, Flynn, Solomon, & Stewart, 2015)

Bursitis- limited ROM, swelling, pain, warmth, and point tenderness (Ball, Dains, Flynn, Solomon, & Stewart, 2015)

References

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.

Polzer, H., Kanz, K. G., Prall, W. C., Haasters, F., Ockert, B., Mutschler, W., & Grote, S. (2012).

Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthopedic Reviews, 4(1), e5. http://doi.org/10.4081/or.2012.e5

PubMed Health. (2018). Ankle sprains: overview. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072736/

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Urinary Tract Infections

   Discussion: Urinary Tract Infections

Urinary tract infections (UTIs) are caused by bacteria—most often Escherichia coli. However, certain viruses, fungi, and parasites can also lead to infection. The infection can affect the lower and upper urinary tract, including the urethra, prostate (in males), bladder, ureter, and kidney. Due to the progression of the disease and human anatomy, symptoms present differently among the sexes as well as among age groups. It is important to understand how these factors, as well as others, impact the pathophysiology of UTIs. Advanced practice nurses must have this foundation in order to properly diagnose patients.

                                            

                                          To Prepare

Review Chapter 30 in the Huether and McCance text.

Identify the pathophysiology of lower and upper urinary tract infections.      Consider the similarities and differences between the two types of infections.

Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior.

Reflect on how the factors you selected might impact the pathophysiology of the infections, as well as the diagnosis of and treatment for the infections.

Post a description of the pathophysiology of lower and upper urinary tract infections, including their similarities and differences.

Then explain how the factors you selected might impact the pathophysiology of the infections, as well as the diagnosis of and treatment for the infections.

NOTE: This is the link of the book you have to use

https://drive.google.com/file/d/12MGt6z2PicuM1y4rM-SN8rpGD09-Tmkj/view?usp=sharing
https://drive.google.com/file/d/12MGt6z2PicuM1y4rM-SN8rpGD09-Tmkj/view?usp=sharing
Check the documents attached bellow

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disaster recovery plan

Develop a disaster recovery plan to lessen health disparities and improve access to community services after a disaster. Then, develop and record an 8-10 slide presentation (PowerPoint preferred) of the plan with audio for the Vila Health system, city officials, and the disaster relief team.

As you begin to prepare this assessment, you are encouraged to complete the Disaster Preparedness and Management activity. The information gained from completing this activity will help you succeed with the assessment as you think through key issues in disaster preparedness and management in the community or workplace. Completing activities is also a way to demonstrate engagement.

Professional Context

Nurses fulfill a variety of roles, and their diverse responsibilities as health care providers extend to the community. The decisions we make daily and in times of crisis often involve the balancing of human rights with medical necessities, equitable access to services, legal and ethical mandates, and financial constraints. When an unanticipated event occurs, such as an accident or natural disaster, issues can arise that complicate decisions about meeting the needs of an individual or group, including understanding and upholding their rights and desires, mediating conflict, and applying established ethical and legal standards of nursing care. As a nurse, you must be knowledgeable about disaster preparedness to safeguard those in your care. You are also accountable for promoting equitable quality of care for community residents.

This assessment provides an opportunity for you to apply the concepts of emergency preparedness, public health assessment, triage, management, and surveillance after a disaster. You will also focus on hospital evacuation and extended displacement periods.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 1: Analyze health risks and health care needs among distinct populations.
    • Describe the determinants of health and the cultural, social, and economic barriers that impact safety, health, and disaster recovery efforts in a community.
  • Competency 2: Propose health promotion strategies to improve the health of populations.
    • Present specific, evidence-based strategies to overcome communication barriers and enhance interprofessional collaboration to improve disaster recovery efforts.
  • Competency 3: Evaluate health policies, based on their ability to achieve desired outcomes.
    • Explain how health and governmental policy affect disaster recovery efforts.
  • Competency 4: Integrate principles of social justice in community health interventions.
    • Explain how a proposed disaster recovery plan will lessen health disparities and improve access to community services.
  • Competency 5: Apply professional, scholarly communication strategies to lead health promotion and improve population health.
    • Present a compelling case to community stakeholders to obtain their approval and support for a proposed disaster recovery plan.

Note: Complete the assessments in this course in the order in which they are presented.

Preparation

When disaster strikes, community members must be protected. A comprehensive recovery plan, guided by the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework, is essential to help ensure everyone’s safety. The unique needs of residents must be assessed to lessen health disparities and improve access to equitable services after a disaster. Recovery efforts depend on the appropriateness of the plan, the extent to which key stakeholders have been prepared, and the allocation of available resources. In a time of cost containment, when personnel and resources may be limited, the needs of residents must be weighed carefully against available resources.

In this assessment, you are a member of a community task force responsible for developing a disaster recovery plan for the Vila Health community using MAP-IT, which you will present to city officials and the disaster relief team.

To prepare for the assessment, complete the Vila Health: Disaster Recovery Scenario simulation.

In addition, you are encouraged to complete the Disaster Preparedness and Management activity. The information gained from completing this activity will help you succeed with the assessment as you think through key issues in disaster preparedness and management in the community or workplace. Completing activities is also a way to demonstrate engagement.

Begin thinking about:

  • Community needs.
  • Resources, personnel, budget, and community makeup.
  • People accountable for implementation of the disaster recovery plan.
  • Healthy People 2020 goals.
  • A timeline for the recovery effort.

You may also wish to:

  • Review the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework, which you will use to guide the development of your plan:
    • Mobilize collaborative partners.
    • Assess community needs.
    • Plan to lessen health disparities and improve access to services.
    • Implement a plan to reach Healthy People 2020 objectives.
    • Track community progress.
  • Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete.

Note: Remember that you can submit all, or a portion of, your draft recovery plan to Smarthinking Tutoring for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.

Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact [email protected] to request accommodations.

Instructions

Complete the following:

  1. Develop a disaster recovery plan for the Vila Health community that will lessen health disparities and improve access to services after a disaster. Refer back to the Vila Health: Disaster Recovery Scenario to understand the Vila Health community.
    • Assess community needs.
    • Consider resources, personnel, budget, and community makeup.
    • Identify the people accountable for implementation of the plan and describe their roles.
    • Focus on specific Healthy People 2020 goals.
    • Include a timeline for the recovery effort.
  2. Use the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework to guide the development of your plan:
    • Mobilize collaborative partners.
    • Assess community needs.
    • Plan to lessen health disparities and improve access to services.
    • Implement a plan to reach Healthy People 2020 objectives.
    • Track community progress.
  3. Develop a slide presentation of your disaster recovery plan with an audio recording of you presenting your assessment of the Vila Health: Disaster Recovery Scenario for city officials and the disaster relief team.
Presentation Format and Length

You may use Microsoft PowerPoint (preferred) or other suitable presentation software to create your slides and add your voice-over. If you elect to use an application other than PowerPoint, check with your instructor to avoid potential file compatibility issues.

Be sure that your slide deck includes the following slides:

  • Title slide.
    • Recovery plan title.
    • Your name.
    • Date.
    • Course number and title.
  • References (at the end of your presentation).

Your slide deck should consist of 8–10 content slides plus title and references slides. Use the speaker’s notes section of each slide to develop your talking points and cite your sources as appropriate.

The following resources will help you create and deliver an effective presentation:

Supporting Evidence

Cite at least three credible sources from peer-reviewed journals or professional industry publications to support your plan.

Graded Requirements

The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point:

  • Describe the determinants of health and the cultural, social, and economic barriers that impact safety, health, and recovery efforts in the community.
    • Consider the interrelationships among these factors.
  • Explain how your proposed disaster recovery plan will lessen health disparities and improve access to community services.
    • Consider principles of social justice and cultural sensitivity with respect to ensuring health equity for individuals, families, and aggregates within the community.
  • Explain how health and governmental policy impact disaster recovery efforts.
    • Consider the implications for individuals, families, and aggregates within the community of legislation that includes, but is not limited to, the Americans with Disabilities Act (ADA), the Robert T. Stafford Disaster Relief and Emergency Assistance Act, and the Disaster Recovery Reform Act (DRRA).
  • Present specific, evidence-based strategies to overcome communication barriers and enhance interprofessional collaboration to improve the disaster recovery effort.
    • Consider how your proposed strategies will affect members of the disaster relief team, individuals, families, and aggregates within the community.
    • Include evidence to support your strategies.
  • Present a compelling case to community stakeholders to obtain their approval and support for the proposed disaster recovery plan.
    • Develop your presentation with a specific purpose and audience in mind.
    • Adhere to scholarly and disciplinary writing standards and APA formatting requirements.

Additional Requirements

Before submitting your assessment, proofread all elements to minimize errors that could distract readers and make it difficult for them to focus on the substance of your presentation.

Portfolio Prompt: Remember to save the assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

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chronic myelogenous leukemia

FNU Pathophysiology Quiz

Question 1

A 70-year-old woman has received a diagnosis of chronic myelogenous leukemia (CML) after a clinical investigation sparked by the presence of leukocytosis in her routine blood work. What clinical course should her care provider tell her to expect?

Answers:

A. “It’s likely that this will give you chronic fatigue and malaise for the rest of your life, but that will probably be the extent of your symptoms.”

B. “Unfortunately, your leukemia will likely enter a crisis mode within a few weeks if we don’t treat it immediately.”

C. “You could remain the chronic stage of CML for several years before it accelerates and culminates in a crisis.”

D. “You can expect your blood results, fatigue, and susceptibility to infection to gradually worsen over a few years.”

Question 2

Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the

Answers:

A. erythrocytes.

B. basophils.

C. neutrophils.

D. albumin.

Question 3

Which of the following diagnostic findings is likely to result in the most serious brain insult?

Answers:

A. Moderate decrease in brain tissue volume secondary to a brain tumor removal

B. High intracellular concentration of glutamate

C. Increased ICP accompanied by hyperventilation

D. Mean arterial pressure (MAP) that equals intracranial pressure (ICP)

Question 4

Which of the following patients would be most likely to be experiencing an increase in renal erythropoietin production?

Answers:

A. A 70-year-old woman admitted with dehydration secondary to an overdose of her potassium-wasting diuretic

B. A 21-year-old man with acute blood loss secondary to a motor vehicle accident 3 hours prior

C. A 68-year-old man with a long-standing diagnosis of polycythemia vera

D. A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD)

Question 5

A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts is likely responsible for his symptoms?

Answers:

A. Localized ischemia with areas of necrosis noted on CT angiography

B. High pressure and local hemorrhage of the venous system

C. Hydrocephalus and protein in the cerebral spinal fluid

D. Increased tissue perfusion at the site of the malformation

Question 6

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

A. interleukin cells.

B. Philadelphia.

C. PSA.

D. BRCA-1.

Question 7

A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessments and interventions should the nursing staff of the unit prioritize in their care?

Answers:

A. Regular pain assessment and administration of opioid analgesics as needed

B. Cardiac monitoring and administration of inotropic medications

C. Assessment and documentation of cognitive changes, including confusion and restlessness

D. Assessment of swallowing ability and respiratory status

Question 8

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. What will be the primary goal of his treatment?

Answers:

A. To increase the amount of oxygen distributed by his red blood cells

B. To reduce the viscosity of his blood

C. To reduce the mean size of his red cells

D. To control his hypertension

Question 9

During a late night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system contains the highest level of control of her arm and hand action?

Answers:

A. Thalamus

B. Cerebellum

C. Frontal lobe

D. Basal ganglia

Question 10

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

Answers:

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

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

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

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

Question 11

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

Answers:

A. Hemophilia B

B. Vitamin K deficiency

C. Excess calcium

D. Idiopathic immune thrombocytopenic purpura (ITP)

Question 12

Your ESRD patient is receiving 2 units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56.What is the nurse’s priority action? Answers:

A. Recheck the type of blood infusing with the chart documentation of patient’s blood type. B. Discontinue the transfusion and begin an infusion of normal saline.

C. Slow the rate of the blood infusion to 50 mL/hour.

D. Document the assessment as the only action.

Question 13

A 5th grade elementary student asks the school nurse how much blood is in an entire body. The nurse should respond that the average grown-up adult has

Answers:

A. 2 to 4 cups of blood in his or her body.

B. 5 to 6 L of blood throughout his or her body.

C. 3 pints of blood in total.

D. 3 to 4 quarts of blood in his or her body.

Question 14

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

Answers:

A. Preventing demyelination of the efferent cerebellar pathways

B. Preventing axonal degradation of motor neurons

C. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions

D. Increasing the functional ability of the underactive dopaminergic system

Question 15

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

Answers:

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

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

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

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

Question 16

Several months ago, a 20-year-old male suffered a spinal cord injury brought about by a snowboard trick gone wrong. The lasting effects of his injury include a flaccid bowel and bladder and the inability to obtain an erection. While sensation has been completely preserved in his legs and feet, his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced?

Answers:

A. Central cord syndrome

B. Conus medullaris syndrome

C. Brown-Séquard syndrome

D. Anterior cord syndrome

Question 17

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

Answers:

A. A–

B. A

C. B–

D. B

Question 18

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

Answers:

A. has vomited and complained of a severe headache.

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

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

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

Question 19

Amniocentesis has suggested that a couple’s first child will be born with sickle cell disease. The parents are unfamiliar with the health problem, and their caregiver is explaining the complexities. Which of the following statements by the parents would suggest a need for further teaching or clarification?

Answers:

A. “Our baby’s red cells are prone to early destruction because of his or her weak membranes.”

B. “Our son or daughter likely won’t show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies.”

C. “Not all of his or her red cells will be sickled, but low oxygen levels can cause them to become so.”

D. “Sickled cells can block his or her blood vessels, especially in the abdomen, chest, and bones.”

Question 20

During science class, a student asks, “What’s the difference between plasma and serum in the blood?” The nurse responds that the primary difference between plasma and serum is that plasma contains

Answers:

A. hydrogen ions.

B. heparin.

C. white blood cells.

D. fibrinogen.

Question 21

During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his medical history. The patient asks, “What is that?” How should the nursing student reply?

Answers:

A. “A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles”

B. “Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot”

C. “A degenerative disease where you have trouble walking without the help of a cane or walker”

D. “Swelling of your arm where you got your flu shot, and maybe your eyes and lips had some swelling as well”

Question 22

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

Answers:

A. Excess acetylcholinesterase production; treatment with thymectomy

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

C. Cerebellar lesions; surgical and immunosuppressive treatment

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

Question 23

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

Answers:

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

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

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

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

Question 24

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

A. Growth factors and cytokines

B. T lymphocytes and natural killer cells

C. Neutrophils and eosinophils

D. Natural killer cells and granulocytes

Question 25

While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB-GYN physician has called in a specialist who thinks that the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders?

Answers:

A. Immediately discontinue the heparin therapy

B. Switch to Coumadin 2.5 mg once/day

C. Decrease the dose of heparin from 5000 units b.i.d to 3000 units b.i.d

D. Infuse FFP stat

Question 26

Which of the following individuals would most likely experience global ischemia to his or her brain?

Answers:

A. A woman who is being brought to hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater

B. A male client who has just had an ischemic stroke confirmed by CT of his head

C. A woman who has been admitted to the emergency department with a suspected intracranial bleed

D. A man who has entered cardiogenic shock following a severe myocardial infarction

Question 27

A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor?

Answers:

A. Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)

B. Hepatic immaturity of the infant

C. Hypoxia

D. The fact that the infant is being breast-fed

Question 28

A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms?

Answers:

A. Viruses are killing some of his B cells and becoming incorporated into the genome of others.

B. The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.

C. The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.

D. The EBV inhibits the maturation of white cells within his peripheral lymph nodes.

Question 29

A 16-year-old female has been brought to her primary care physician by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the physician to rule out infectious mononucleosis?

Answers:

A. Chest auscultation reveals crackles in her lower lung fields bilaterally.

B. Her liver and spleen are both enlarged.

C. Blood work reveals an increased white blood cell count.

D. The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.

Question 30

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client’s husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse’s following statements best characterizes DIC?

Answers:

A. “The same hormones and bacteria that cause clotting also cause bleeding.”

B. “Massive clotting causes irritation, friction, and bleeding in the small blood vessels.”

C. “So much clotting takes place that there are no available clotting components left, and bleeding ensues.”

D. “Excessive activation of clotting causes an overload of vital organs, resulting in bleeding.”

Question 31

A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate?

Answers:

A. “Our treatment plan will depend on whether your tumor is malignant or benign.”

B. “This is likely a result of a combination of heredity and lifestyle.”

C. “The major risk that you face is metastases to your lungs, liver, or bones.”

D. “Your prognosis will depend on whether we can surgically resect your tumor.”

Question 32

A patient diagnosed with low-risk chronic lymphocytic leukemia (CLL) has recently developed thrombocytopenia. One of the medications utilized to treat this would be Answers:

A. cisplatin, a chemotherapeutic.

B. vincristine, a Vinca alkaloid.

C. dexamethasone, a corticosteroid.

D. doxorubicin, a cytotoxic antibiotic.

Question 33

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

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

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

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

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

Question 34

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

Answers:

A. Tissue destruction results from neutrophil deactivation.

B. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

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

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

Question 35

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

Answers:

A. Encephalitis

B. Lyme disease

C. Rocky Mountain spotted fever

D. Spinal infection

Question 36

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

Answers:

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

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

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

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

Question 37

A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to touch. Which of the following hematological processes is most likely occurring in the bone marrow in response to the infection?

Answers:

A. Phagocytosis by myelocytes

B. Increased segmented neutrophil production

C. High circulatory levels of myeloblasts

D. Proliferation of immature neutrophils

Question 38

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate?

Answers:

A.“We think that his spleen is inhibiting the production of platelets by his bone marrow.”

B.“We believe that your son’s spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk.”

C.“Your son’s spleen is holding on to too many of his platelets, so they’re not available for clotting.”

D.“Your son’s spleen is inappropriately filtering out the platelets from his blood and keeping them from normal circulation.”

Question 39 A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems?

Answers:

A. Anemia

B. Blood clots

C. Jaundice

D. Infections

Question 40

A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty in maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health, but knew that women often need additional iron, she added a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination, her spleen is noted to be enlarged. Which of the following is most likely to be the cause?

Answers:

A. CLL

B. Accelerated CML

C. Infectious mononucleosis

D. Stage A Hodgkin disease

Question 41

A nurse is providing care for several patients on an acute medical unit of a hospital.Which of the following patients would be most likely to benefit from hematopoietic growth factors?

Answers:

A. A 61-year-old female patient with end-stage renal cancer

B. A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes

C. A 51-year-old female patient with liver failure secondary to hepatitis

D. A 44-year-old man with a newly diagnosed brain tumor

Question 42

Misinterpreting her physician’s instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status?

Answers:

A. The binding of an antibody to platelet factor IV produces immune complexes.

B. The patient’s prostaglandin (TXA2) levels are abnormally high.

C. Irreversible acetylation of platelet cyclooxygenase activity has occurred.

D. She is at risk of developing secondary immune thrombocytopenic purpura (ITP).

Question 43 Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of von Willebrand disease?

Answers:

A. “Make sure that you avoid taking aspirin.”

B. “Your disease affects your platelet function rather than clot formation.”

C. “Clotting factor VIII can help your body compensate for the difficulty in clotting.”

D. “It’s important that you avoid trauma.”

Question 44

A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs

Answers:

A. are caused by small bleeds that can be a warning sign of an impending stroke.

B. are a relatively benign sign that necessitates monitoring but not treatment.

C. are an accumulation of small deficits that may eventually equal the effects of a full CVA. D. resolve rapidly but may place the client at an increased risk for stroke.

Question 45

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

Answers:

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

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

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

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

Question 46

A couple who is expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting it. How can their caregiver best respond to the couple’s enquiry? Stem cells can

Answers:

A. “be used as source of reserve cells for the entire blood production system.”

B. “help treat some cancers and anemias, but they must come from your child himself or herself.”

C. “be used to regenerate damaged organs should the need ever arise.”

D. “help correct autoimmune diseases and some congenital defects.”

Question 47 A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate?

Answers:

A. “Ferritin is a protein–iron complex that allows your red blood cells to make use of the iron that you consume in your diet.”

B. “Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen.”

C. “Ferritin is the form of iron that is transported in your blood plasma to red blood cells that need it.”

D. “Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills.”

Question 48

A 13-year-old African American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out?

Answers:

A. Aplastic anemia

B. Sickle cell anemia

C. Thalassemia

D. Iron deficiency anemia

Question 49

In which of the following patients, would diagnostic investigations least likely reveal increased thrombopoietin production?

Answers:

A. A 55-year-old man with dehydration secondary to Crohn disease

B. An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive

C. A 66-year-old woman with a diagnosis of lung cancer with bone metastases

D. A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia

Question 50

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

Answers:

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

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

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

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

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identification and application

Details:

In nursing practice, accurate identification and application of research is essential to achieving successful outcomes. Being able to articulate the information and successfully summarize relevant peer-reviewed articles in a scholarly fashion helps to support the student’s ability and confidence to further develop and synthesize the progressively more complex assignments that constitute the components of the course change proposal capstone project.  For this assignment, the student will provide a synopsis of eight peer-reviewed articles from nursing journals using an evaluation table that determines the level and strength of evidence for each of the eight articles. The articles should be current within the last 5 years and closely relate to the PICOT statement developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project. Use the “Literature Evaluation Table” resource to complete this assignment.  While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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

You are not required to submit this assignment to Turnitin.

NRS-490-RS-LiteratureEvaluationTable.docx

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