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Critiquing a Qualitative Research Study

Critiquing a Qualitative Research Study

For this assignment, you will be writing  your own QUALITATIVE study critique (similar to what you did for me last week for the quantitative study critique, only this time critiquing a QUALITATIVE research study) on one of the studies provided to you.

Choose one qualitative journal article from this list:

Biezen, R., Grando, D., Mazza, D., & Brijnath, B. (2019). Visibility and transmission: complexities around promoting hand hygiene in young children: A qualitative studyBMC Public Health, 19(1), no pages.

da Silva Lins, H. N., Macêdo Paiva, L. K., Gonçalves de Souza, M., Cassimiro Lima, R. M., & Albuquerque, N. L. A. (2019). Experiences in women’s care: Doulas’ perceptionJournal of Nursing UFPE / Revista de Enfermagem UFPE, 13(5), 1264–1269.

Mele, B., Goodarzi, Z., Hanson, H. M., & Holroyd-Leduc, J. (2019). Barriers and facilitators to diagnosing and managing apathy in Parkinson’s disease: A qualitative studyBMC Neurology, 19(1), no pages.

Assignment Instructions

– Read your selected journal article entirely.

– Analyze the journal article and use the specific questions that are outlined in Gray, Grove, and Sutherland (2017) found on the attachment section to construct your analysis of your chosen QUALITATIVE research study. (See Word Attachment)

These are the main headers of your paper:

1- Identifying the Steps of the Qualitative Research Process

2- Determination of Strengths and Weaknesses of Qualitative Studies

3- Evaluating a Qualitative Study

You have many questions to address in your assignment. They should be in complete sentences (i.e., bullet point responses are not acceptable!).

– APA format is required in your assignment Word document.

– Page length, excluding the title and references list, is between five and seven pages.

– Minimun Two (2)  references.

– Free of plagiarism (Turnitin Assignment)

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Communicable Disease Selection

Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.

Communicable Disease Selection

Chickenpox
Tuberculosis
Influenza
Mononucleosis
Hepatitis B
HIV
Ebola
Measles
Polio
Influenza
Epidemiology Paper Requirements

Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
Describe the social determinants of health and explain how those factors contribute to the development of this disease.
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?
Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.
A minimum of three peer-reviewed or professional references is required.

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

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

You are required to submit this assignment to Turn it in

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e identification and application of research

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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Worldview Analysis and Personal Inventory 

Worldview Analysis and Personal Inventory

Based on the required topic study materials, write a reflection about worldview and respond to following:

  1. In 250-300 words, explain the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism within health care.
  2. In 250-300 words, explain what scientism is and describe two of the main arguments against it.
  3. In 750-1,000 words, answer each of the worldview questions according to your own personal perspective and worldview: (a) What is ultimate reality? (b) What is the nature of the universe? (c) What is a human being? (d) What is knowledge? (e) What is your basis of ethics? (f) What is the purpose of your existence?

Remember to support your reflection with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting 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 required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Worldview Analysis and Personal Inventory – Rubric

No of Criteria: 8 Achievement Levels: 5CriteriaAchievement LevelsDescriptionPercentageUnsatisfactory0.00 %Less than Satisfactory65.00 %Satisfactory75.00 %Good85.00 %Excellent100.00 %Content70.0     Christian Perspective of Spirituality and Ethics in Contrast to Postmodern Relativism20.0Explanation of the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism is incomplete or insufficient.Explanation of the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism is unclear. Explanation is not supported by topic study materials.Explanation of the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism is clear. Explanation is not supported by topic study materials.Explanation of the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism is clear and detailed. Explanation is supported by topic study materials.Explanation of the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism is clear, detailed, and demonstrates a deep understanding of the subject. Explanation is supported by topic study materials.Scientism and Arguments20.0Explanation of scientism or the explanations of two main arguments against scientism are inaccurate. Details are not supported.Description of scientism is accurate. Explanations of two main arguments against scientism are unclear. Details are not clearly supported by topic study materials.Explanation of scientism is clear. Explanations of two main arguments against scientism are clear. Details are supported by topic study materials.Explanation of scientism is clear and accurate. Explanations of two main arguments against scientism are clear. Details are clearly supported by topic study materials.Explanation of scientism is clear and accurate. Explanations of two main arguments against scientism are clear and insightful. Details are clearly supported by topic study materials.Personal Perspective and Worldview 30.0Worldview questions are not fully answered.Each of the worldview questions is answered but is lacking a personal connection or clarity. Each of the worldview questions is answered with personal connection. Each of the worldview questions is answered clearly and with personal connection.Each of the worldview questions is answered clearly and with deep personal insight.Organization, Effectiveness, and Format 30.0     Thesis Development and Purpose7.0Paper lacks any discernible overall purpose or organizing claim.Thesis is insufficiently developed or vague. Purpose is not clear.Thesis is apparent and appropriate to purpose.Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.Argument Logic and Construction8.0Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.Mechanics of Writing (includes spelling, punctuation, grammar, language use)5.0Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.Writer is clearly in command of standard, written, academic English.Paper Format (use of appropriate style for the major and assignment)5.0Template is not used appropriately, or documentation format is rarely followed correctly.Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style.All format elements are correct. Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)5.0Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Percentage  100

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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:

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.

This work should have Introduction and conclusion

– This work should have at 3 to 5current references (Year 2012 and up)

– Use at least 2 references from class Learning Resources

The following Resources are not acceptable:

1. Wikipedia

2. Cdc.gov- nonhealthcare professionals section

3. Webmd.com

4. Mayoclinic.com

Required Readings

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

  • Chapter 33, “Prostatic      Disorders and Erectile Dysfunction” (pp. 527-544)
    This chapter examines the causes, pathophysiology, and drug treatment of      four disorders: prostatitis, benign prostatic hyperplasia, prostate      cancer, and erectile dysfunction. It also explores the importance of      monitoring patient response and patient education.
  • Chapter 34, “Overactive      Bladder” (pp. 545-564)
    This chapter describes the causes, pathophysiology, diagnostic criteria,      and evaluation of overactive bladder. It also outlines the process of      initiating, administering, and managing drug treatment for this disorder.
  • Chapter 55, “Contraception”      (pp. 959-970)
    This chapter examines various methods of contraception and covers drug      interactions, selecting the most appropriate agent, and monitoring patient      response to contraceptions.
  • Chapter 56, “Menopause” (pp.      971-994)
    This chapter presents various options for menopausal hormone therapy and      examines the strengths and limitations of each form of therapy.
  • Chapter 57, “Osteoporosis” (pp.      985-994)
    This chapter covers various options for treating osteoporosis. It also      describes proper dosages, potential adverse reactions, and special      considerations of each drug.
  • Chapter 58, “Vaginitis” (pp. 995-1006)
    This chapter examines various causes of vaginitis and explores the      diagnostic criteria and methods of treatment for the disorder.

Holloway, D. (2010). Clinical update on hormone replacement therapy. British Journal of Nursing, 19(8), 496–504

This article examines the purpose, components, and administration of hormone replacement therapy (HRT). It also presents benefits, risks, potential side effects, and alternative treatment options of HRT.

Mäkinen, J. I., & Huhtaniemi, I. (2011). Androgen replacement therapy in late-onset hypogonadism: Current concepts and controversies—A mini-review. Gerontology, 57(3), 193–202.

This article examines the role of testosterone levels in the development of hypogonadism. It also explores health issues that are impacted by testosterone levels and the role of testosterone replacement therapy.

Drugs.com. (2012). Retrieved from http://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

U.S. Preventive Services Task Force. (2014). The Guide to Clinical Preventive Services: Section 2. Recommendations for Adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html

This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, 

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Clinical Judgment in Nursing

Read the article “Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing” by Christine Tanner, which is linked below:

Link to article http://content.ebscohost.com/ContentServer.asp?T=P&P=AN&K=106314107&S=R&D=rzh&EbscoContent=dGJyMNHX8kSeprI4y9f3OLCmr1GeprdSsKa4Sq%2BWxWXS&ContentCustomer=dGJyMPGvrk%2B0prBLuePfgeyx43zx

In at least three pages, answer the following questions:

also below

  1. What do you feel are the greatest influences on clinical judgment? Is it experience, knowledge, or a combination of those things?
  2. In your opinion, what part does intuition play in clinical judgment? How do you think you’ll be able to develop nursing intuition?

Additional sources are not required but if they are used, please cite them in APA format.

Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing

Christine A. Tanner, PhD, RN

ABsTRACT

This article reviews the growing body of research on clinical judgment in nursing and presents an alternative model of clinical judgment based on these studies. Based on a review of nearly 200 studies, five conclusions can be drawn: (1) Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand; (2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns; (3) Clinical judg- ments are influenced by the context in which the situation occurs and the culture of the nursing care unit; (4) Nurses use a variety of reasoning patterns alone or in combina- tion; and (5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the de- velopment of clinical knowledge and improvement in clini- cal reasoning. A model based on these general conclusions emphasizes the role of nurses’ background, the context of the situation, and nurses’ relationship with their patients as central to what nurses notice and how they interpret findings, respond, and reflect on their response.

Clinical judgment is viewed as an essential skill for virtually every health professional. Florence Nightingale (1860/1992) firmly established that observations and their interpretation were the hallmarks of trained nursing practice. In recent years, clinical judg-

Dr.Tanner is A.B.Youmans-Spaulding Distinguished Professor, Ore- gon & Health Science University, School of Nursing, Portland, Oregon.

Address correspondence to Christine A. Tanner, PhD, RN, A.B. Youmans-Spaulding Distinguished Professor, Oregon & Health Sci- ence University, School of Nursing, 3455 SW U.S. Veterans Hospital Road, Portland, OR 97239; e-mail: [email protected].

ment in nursing has become synonymous with the widely adopted nursing process model of practice. In this model, clinical judgment is viewed as a problem-solving activity, beginning with assessment and nursing diagnosis, pro- ceeding with planning and implementing nursing inter- ventions directed toward the resolution of the diagnosed problems, and culminating in the evaluation of the effec- tiveness of the interventions. While this model may be useful in teaching beginning nursing students one type of systematic problem solving, studies have shown that it fails to adequately describe the processes of nursing judgment used by either beginning or experienced nurses (Fonteyn, 1991; Tanner, 1998). In addition, because this model fails to account for the complexity of clinical judg- ment and the many factors that influence it, complete reli- ance on this single model to guide instruction may do a significant disservice to nursing students. The purposes of this article are to broadly review the growing body of re- search on clinical judgment in nursing, summarizing the conclusions that can be drawn from this literature, and to present an alternative model of clinical judgment that captures much of the published descriptive research and that may be a useful framework for instruction.

DefiNiTioN of TeRMs

In the nursing literature, the terms “clinical judg- ment,” “problem solving,” “decision making,” and “critical thinking” tend to be used interchangeably. In this article, I will use the term “clinical judgment” to mean an inter- pretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response. “Clinical reasoning” is the term I will use to refer to the processes by which nurses and other clinicians make their judgments, and includes both the deliberate process of

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Journal of Nursing Education

generating alternatives, weighing them against the evi- dence, and choosing the most appropriate, and those pat- terns that might be characterized as engaged, practical reasoning (e.g., recognition of a pattern, an intuitive clini- cal grasp, a response without evident forethought).

Clinical judgment is tremendously complex. It is re- quired in clinical situations that are, by definition, under- determined, ambiguous, and often fraught with value con- flicts among individuals with competing interests. Good clinical judgment requires a flexible and nuanced ability to recognize salient aspects of an undefined clinical situa- tion, interpret their meanings, and respond appropriately. Good clinical judgments in nursing require an under- standing of not only the pathophysiological and diagnostic aspects of a patient’s clinical presentation and disease, but also the illness experience for both the patient and fam- ily and their physical, social, and emotional strengths and coping resources.

Adding to this complexity in providing individualized patient care are many other complicating factors. On a typical acute care unit, nurses often are responsible for five or more patients and must make judgments about priorities among competing patient and family needs (ebright, Patterson, Chalko, & Render, 2003). In addition, they must manage highly complicated processes, such as resolving conflicting family and care provider information, managing patient placement to appropriate levels of care, and coordinating complex discharges or admissions, amid interruptions that distract them from a focus on their clinical reasoning (ebright et al., 2003). Contemporary models of clinical judgment must account for these com- plexities if they are to inform nurse educators’ approaches to teaching.

ReseARCh oN CLiNiCAL JuDgMeNT

The literature review completed for this article updates a prior review (Tanner, 1998), which covered 120 articles retrieved through a CINAHL database search using the terms “clinical judgment” and “clinical decision making,” limited to english language research and nursing jour- nals. Since 1998, an additional 71 studies on these topics have been published in the nursing literature. These stud- ies are largely descriptive and seek to address questions such as:

l What are the processes (or reasoning patterns) used by nurses as they assess patients, selectively attend to clinical data, interpret these data, and respond or inter- vene?

l What is the role of knowledge and experience in these processes?

l What factors affect clinical reasoning patterns?

The description of processes in these studies is strongly re- lated to the theoretical perspective driving the research. For example, studies using statistical decision theory describe the use of heuristics, or rules of thumb, in decision making, demonstrating that human judges are typically poor infor- mal statisticians (Brannon & Carson, 2003; O’Neill, 1994a,

1994b, 1995). Studies using information processing theory fo- cus on the cognitive processes of problem solving or diagnos- tic reasoning, accounting for limitations in human memory (Grobe, Drew, & Fonteyn, 1991; Simmons, Lanuza, Fonteyn, Hicks, & Holm, 2003). Studies drawing on phenomenologi- cal theory describe judgment as an situated, particularistic, and integrative activity (Benner, Stannard, & Hooper, 1995; Benner, Tanner, & Chesla, 1996; Kosowski & Roberts, 2003; Ritter, 2003; White, 2003).

Another body of literature that examines the processes of clinical judgment is not derived from one of these tradi- tional theoretical perspectives, but rather seeks to describe nurses’ clinical judgments in relation to particular clinical issues, such as diagnosis and intervention in elder abuse (Phillips & Rempusheski, 1985), assessment and manage- ment of pain (Abu-Saad & Hamers, 1997; Ferrell, eberts, McCaffery, & Grant, 1993; Lander, 1990; McCaffery, Fer- rell, & Pasero, 2000), and recognition and interpretation of confusion in older adults (McCarthy, 2003b).

In addition to differences in theoretical perspectives and study foci, there are also wide variations in research methods. Much of the early work relied on written case scenarios, presented to participants with the requirement that they work through the clinical problem, thinking aloud in the process, producing “verbal protocols for analy- sis” (Corcoran, 1986; Redden & Wotton, 2001; Simmons et al., 2003; Tanner, Padrick, Westfall, & Putzier, 1987) or re- spond to the vignette with probability estimates (McDon- ald et al, 2003; O’Neill, 1994a). More recently, research has attempted to capture clinical judgment in actual prac- tice through interpretation of narrative accounts (Ben- ner et al., 1996, 1998; Kosowski & Roberts, 2003; Parker, Minick, & Kee, 1999; Ritter, 2003; White, 2003), observa- tions of and interviews with nurses in practice (McCarthy, 2003b), focused “human performance interviews” (ebright et al., 2003; ebright, Urden, Patterson, & Chalko, 2004), chart audit (Higuchi & Donald, 2002), self-report of deci- sion-making processes (Lauri et al., 2001), or some com- bination of these. Despite the variations in theoretical perspectives, study foci, research methods, and resulting descriptions, some general conclusions can be drawn from this growing body of literature.

Clinical Judgments Are More influenced by What the Nurse Brings to the situation than the objective Data About the situation at hand

Clinical judgments require various types of knowledge: that which is abstract, generalizable, and applicable in many situations and is derived from science and theory; that which grows with experience where scientific ab- stractions are filled out in practice, is often tacit, and aids instant recognition of clinical states; and that which is highly localized and individualized, drawn from knowing the individual patient and shared human understanding (Benner, 1983, 1984, 2004; Benner et al., 1996, Peden- McAlpine & Clark, 2002).

For the experienced nurse encountering a familiar situation, the needed knowledge is readily solicited; the

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CLINICAL jUDGMeNT MODeL

nurse is able to respond intuitively, based on an immedi- ate clinical grasp and just “knowing what to do” (Cioffi, 2000). However, the beginning nurse must reason things through analytically; he or she must learn how to recog- nize a situation in which a particular aspect of theoretical knowledge applies and begin to develop a practical knowl- edge that allows refinement, extensions, and adjustment of textbook knowledge.

The profound influence of nurses’ knowledge and philosophical or value perspectives was demonstrated in a study by McCarthy (2003b). She showed that the wide variation in nurses’ ability to identify acute confusion in hospitalized older adults could be attributed to differenc- es in nurses’ philosophical perspectives on aging. Nurses “unwittingly” adopt one of three perspectives on health in aging: the decline perspective, the vulnerable perspective, or the healthful perspective. These perspectives influence the decisions the nurses made and the care they provided. Similarly, a study conducted in Norway showed the influ- ence of nurses’ frameworks on assessments completed and decisions made (ellefsen, 2004).

Research by Benner et al. (1996) showed that nurses come to clinical situations with a fundamental disposition toward what is good and right. Often, these values remain unspoken, and perhaps unrecognized, but nevertheless profoundly influence what they attend to in a particular situation, the options they consider in taking action, and ultimately, what they decide. Benner et al. (1996) found common “goods” that show up across exemplars in nurs- ing, for example, the intention to humanize and personal- ize care, the ethic for disclosure to patients and families, the importance of comfort in the face of extreme suffering or impending death—all of which set up what will be no- ticed in a particular clinical situation and shape nurses’ particular responses.

Therefore, undertreatment of pain might be understood as a moral issue, where action is determined more by cli- nicians’ attitudes toward pain, value for providing com- fort, and institutional and political impediments to moral agency than by a good understanding of the patient’s ex- perience of pain (Greipp, 1992). For example, a study by McCaffery et al. (2000) showed that nurses’ personal opin- ions about a patient, rather than recorded assessments, influence their decisions about pain treatment. In addi- tion, Slomka et al. (2000) showed that clinicians’ values influenced their use of clinical practice guidelines for ad- ministration of sedation.

sound Clinical Judgment Rests to some Degree on Knowing the Patient and his or her Typical Pattern of Responses, as well as engagement with the Patient and his or her Concerns

Central to nurses’ clinical judgment is what they de- scribe in their daily discourse as “knowing the patient.” In several studies (jenks, 1993; jenny & Logan, 1992; MacLeod, 1993; Minick, 1995; Peden-McAlpine & Clark, 2002; Tanner, Benner, Chesla, & Gordon, 1993), investiga- tors have described nurses’ taken-for-granted understand-

ing of their patients, which derives from working with them, hearing accounts of their experiences with illness, watching them, and coming to understand how they typi- cally respond. This type of knowing is often tacit, that is, nurses do not make it explicit, in formal language, and in fact, may be unable to do so.

Tanner et al. (1993) found that nurses use the language of “knowing the patient” to refer to at least two different ways of knowing them: knowing the patient’s pattern of responses and knowing the patient as a person. Knowing the patient, as described in the studies above, involves more than what can be obtained in formal assessments. First, when nurses know a patient’s typical patterns of responses, certain aspects of the situation stand out as salient, while others recede in importance. Second, quali- tative distinctions, in which the current picture is com- pared to this patient’s typical picture, are made possible by knowing the patient. Third, knowing the patient allows for individualizing responses and interventions.

Clinical Judgments Are influenced by the Context in Which the situation occurs and the Culture of the Nursing unit

Research on nursing work in acute care environments has shown how contextual factors profoundly influence nursing judgment. ebright et al. (2003) found that nurs- ing judgments made during actual work are driven by more than textbook knowledge; they are influenced by knowledge of the unit and routine workflow, as well as by specific patient details that help nurses prioritize tasks.

Benner, Tanner, and Chesla (1997) described the social embeddedness of nursing knowledge, derived from obser- vations of nursing practice and interpretation of narra- tive accounts, drawn from multiple units and hospitals. Benner’s and ebright’s work provides evidence for the significance of the social groups style, habits and culture in shaping what situations require nursing judgment, what knowledge is valued, and what perceptual skills are taught.

A number of studies clearly demonstrate the effects of the political and social context on nursing judgment. Interdisciplinary relationships, notably status inequities and power differentials between nurses and physicians, contribute to nursing judgments in the degree to which the nurse both pursues understanding a problem and is able to intervene effectively (Benner et al., 1996; Bucknall & Thomas, 1997). The literature on pain management con- firms the enormous influence of these factors in adequate pain control (Abu-Saad & Hamers, 1997).

Studies have indicated that decisions to test and treat are associated with patient factors, such as socioeconomic status (Scott, Schiell, & King, 1996). However, others have suggested that social judgment or moral evaluation of pa- tients is socially embedded, independent of patient char- acteristics, and as much a function of the pervasive norms and attitudes of particular nursing units (Grieff & elliot, 1994; johnson & Webb, 1995; Lauri et al., 2001; McCar- thy, 2003a; McDonald et al., 2003).

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Nurses use a Variety of Reasoning Patterns Alone or in Combination

The pattern evoked depends on nurses’ initial grasp of the situation, the demands of the situation, and the goals of the practice. Research has shown at least three interrelated patterns of reasoning used by experienced nurses in their decision making: analytic processes (e.g., hypothetico-deductive processes inherent in diagnostic reasoning), intuition, and narrative thinking. Within each of these broad classes are several distinct patterns, which are evoked in particular situations and may be used alone or in combination with other patterns. Rarely will clini- cians use only one pattern in any particular interaction with a client.

Analytic Processes. Analytic processes are those clini- cians use to break down a situation into its elements. Its primary characteristics are the generation of alternatives and the systematic and rational weighing of those alterna- tives against the clinical data or the likelihood of achiev- ing outcomes. Analytic processes typically are used when:

l One lacks essential knowledge, for example, begin- ning nurses, who might perform a comprehensive assess- ment and then sit down with the textbook and compare the assessment data to all of the individual signs and symptoms described in the book.

l There is a mismatch between what is expected and what actually happens.

l One is consciously attending to a decision because multiple options are available. For example, when there are multiple possible diagnoses or multiple appropriate interventions from which to choose, a rational analytic process will be applied, in which the evidence in favor of each diagnosis or the pros and cons of each intervention are weighed against one another.

Diagnostic reasoning is one analytic approach that has been extensively studied (Crow, Chase, & Lamond, 1995; Crow & Spicer, 1995; Gordon, Murphy, Candee, & Hil- tunen, 1994; Itano, 1989; Lindgren, Hallberg, & Norberg, 1992; McFadden & Gunnett, 1992; O’Neill, 1994a, 1994b, 1995; Tanner et al., 1987; Westfall, Tanner, Putzier, & Pa- drick, 1986; Timpka & Arborelius, 1990).

Intuition. Intuition has also been described in a num- ber of studies. In nearly all of them, intuition is character- ized by immediate apprehension of a clinical situation and is a function of experience with similar situations (Ben- ner, 1984; Benner & Tanner, 1987; Pyles & Stern, 1983; Rew, 1988). In most studies, this apprehension is often recognition of a pattern (Benner et al., 1996; Leners, 1993; Schraeder & Fischer, 1987).

Narrative Thinking. Some evidence also exists that there is a narrative component to clinical reasoning. Twenty years ago, jerome Bruner (1986), a psychologist noted for his studies of cognitive development, argued that humans think in two fundamentally different ways. He labeled the first type of thinking paradigmatic (i.e., thinking through propositional argument) and the second, narrative (i.e., thinking through telling and interpreting stories). The difference between these two types of think-

ing involves how human beings make sense of and explain what they see.

Paradigmatic thinking involves making sense of some- thing by seeing it as an instance of a general type. Con- versely, narrative thinking involves trying to understand the particular case and is viewed as human beings’ prima- ry way of making sense of experience, through an inter- pretation of human concerns, intents, and motives. Nar- rative is rooted in the particular. Robert Coles (1989) and medical anthropologist Arthur Kleinman (1988) have also drawn attention to the narrative component, the storied aspects of the illness experience, suggesting that only by understanding the meaning people attribute to the illness, their ways of coping, and their sense of future possibility can sensitive and appropriate care be provided (Barkwell, 1991). Studies of occupational therapists (Kautzmann, 1993; Mattingly, 1991; Mattingly & Fleming, 1994; McKay & Ryan, 1995), physicians (Borges & Waitzkin, 1995; Hunter, 1991), and nurses (Benner et al., 1996; Zerwekh, 1992) suggest that narrative reasoning creates a deep back- ground understanding of the patient as a person and that the clinicians’ actions can only be understood against that background. Studies also suggest that narrative is an im- portant tool of reflection, that having and telling stories of one’s experience as clinicians helps turn experience into practical knowledge and understanding (Astrom, Norberg, Hallberg, & jansson, 1993; Benner et al., 1996).

Other reasoning patterns have been described in the lit- erature under a variety of names. For example, Benner et al. (1998) explored the use of modus-operandi thinking, or detective work. Brannon and Carson (2003) described the use of several heuristics, as did Simmons et al. (2003). It is clear from the research to date, no single reasoning pat- tern, such as nursing process, works for all situations and all nurses, regardless of level of experience. The reason- ing pattern elicited in any particular situation is largely dependent on nurses’ initial clinical grasp, which in turn, is influenced by their background, the context for decision making, and their relationship with the patient.

Reflection on Practice is often Triggered by Breakdown in Clinical Judgment and is Critical for the Development of Clinical Knowledge and improvement in Clinical Reasoning

Dewey first introduced the idea of reflection and its im- portance to critical thinking in 1933, defining it as “the turning over of a subject in the mind and giving it serious and consecutive consideration” (p. 3). Recent interest in re- flective practice in nursing was fueled, in part, by Schön’s (1983) studies of professional practice and his challenges of the “technical-rationality model” of knowledge in prac- tice disciplines. The past 2 decades have produced a large body of nursing literature on reflection, and two recent reviews provide an excellent synthesis of this literature (Kuiper & Pesut, 2004; Ruth-Sahd, 2003).

Literature linking reflection and clinical judgment is somewhat more sparse. However, some evidence exists that there is typically a trigger event for a reflection, often

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CLINICAL jUDGMeNT MODeL

Figure. Clinical Judgment Model.

a breakdown or perceived breakdown in practice (Benner, 1991; Benner et al., 1996, Boud & Walker, 1998; Wong, Kem- ber, Chung, & Yan, 1995). In her research using narratives from practice, Benner described “narratives of learning,” stories from nurses’ practice that triggered continued and in-depth review of a clinical situation, the nurses’ responses to it, and their intent to learn from mistakes made.

Studies have also demonstrated that engaging in reflec- tion enhances learning from experience (Atkins & Mur- phy, 1993), helps students expand and develop their clini- cal knowledge (Brown & Gillis, 1999; Glaze, 2001, Hyrkas, Tarkka, & Paunonen-Ilmonen, 2001; Paget, 2001), and im- proves judgment in complex situations (Smith, 1998), as well as clinical reasoning (Murphy, 2004).

A ReseARCh-BAseD MoDeL of CLiNiCAL JuDgMeNT

The model of clinical judgment proposed in this article is a synthesis of the robust body of literature on clinical judgment, accounting for the major conclusions derived from that literature. It is relevant for the type of clini- cal situations that may be rapidly changing and require reasoning in transitions and continuous reappraisal and response as the situation unfolds. While the model de- scribes the clinical judgment of experienced nurses, it also provides guidance for faculty members to help students diagnose breakdowns, identify areas for needed growth, and consider learning experiences that focus attention on those areas.

The overall process includes four aspects (figure):

l A perceptual grasp of the situation at hand, termed “noticing.”

l Developing a sufficient understanding of the situa- tion to respond, termed “interpreting.”

l Deciding on a course of action deemed appropri- ate for the situation, which may include “no immediate action,” termed “respond- ing.”

l Attending to patients’ responses to the nursing action while in the process of acting, termed “reflect- ing.”

l Reviewing the out- comes of the action, focus- ing on the appropriate- ness of all of the preceding aspects (i.e., what was noticed, how it was inter- preted, and how the nurse responded).

Noticing

In this model, noticing is not a necessary out- growth of the first step

of the nursing process: assessment. Instead, it is a func- tion of nurses’ expectations of the situation, whether or not they are made explicit. These expectations stem from nurses’ knowledge of the particular patient and his or her patterns of responses; their clinical or practical knowledge of similar patients, drawn from experience; and their text- book knowledge. For example, a nurse caring for a post- operative patient whom she has cared for over time will know the patient’s typical pain levels and responses. Nurs- es experienced in postoperative care will also know the typical pain response for this population of patients and will understand the physiological and pathophysiological mechanisms for pain in surgeries like this. These under- standings will collectively shape the nurse’s expectations for this patient and his pain levels, setting up the possibil- ity of noticing whether those expectations are met.

Other factors will also influence nurses’ noticing of a change in the clinical situation that demands attention, including nurses’ vision of excellent practice, their val- ues related to the particular patient situation, the cul- ture on the unit and typical patterns of care on that unit, and the complexity of the work environment. The factors that shape nurses’ noticing, and, hence, initial grasp, are shown on the left side of the figure.

interpreting and Responding

Nurses’ noticing and initial grasp of the clinical situa- tion trigger one or more reasoning patterns, all of which support nurses’ interpreting the meaning of the data and determining an appropriate course of action. For exam- ple, when a nurse is unable to immediately make sense of what he or she has noticed, a hypothetico-deductive rea- soning pattern might be triggered, through which inter- pretive or diagnostic hypotheses are generated. Additional

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assessment is performed to help rule out hypotheses until the nurse reaches an interpretation that supports most of the data collected and suggests an appropriate response. In other situations, a nurse may immediately recognize a pattern, interpret and respond intuitively and tacitly, confirming his or her pattern recognition by evaluating the patient’s response to the intervention. In this model, the acts of assessing and intervening both support clini- cal reasoning (e.g., assessment data helps guide diag- nostic reasoning) and are the result of clinical reasoning. The elements of interpreting and responding to a clinical situation are presented in the middle and right side of the figure.

Reflection

Reflection-in-action and reflection-on-action together comprise a significant component of the model. Reflection- in-action refers to nurses’ ability to “read” the patient—how he or she is responding to the nursing intervention—and adjust the interventions based on that assessment. Much of this reflection-in-action is tacit and not obvious, unless there is a breakdown in which the expected outcomes of nurses’ responses are not achieved.

Reflection-on-action and subsequent clinical learning completes the cycle; showing what nurses gain from their experience contributes to their ongoing clinical knowledge development and their capacity for clinical judgment in future situations. As in any situation of uncertainty re- quiring judgment, there will be judgment calls that are insightful and astute and those that result in horrendous errors. each situation is an opportunity for clinical learn- ing, given a supportive context and nurses who have de- veloped the habit and skill of reflection-on-practice. To engage in reflection requires a sense of responsibility, connecting one’s actions with outcomes. Reflection also re- quires knowledge outcomes: knowing what occurred as a result of nursing actions.

eDuCATioNAL iMPLiCATioNs of The MoDeL

This model provides language to describe how nurses think when they are engaged in complex, underdeter- mined clinical situations that require judgment. It also identifies areas in which there may be breakdowns where educators can provide feedback and coaching to help stu- dents develop insight into their own clinical thinking. The model also points to areas where specific clinical learning activities might help promote skill in clinical judgment. Some specific examples of its use are provided below.

Faculty in the simulation center at my university have used the Clinical judgment Model as a guide for debrief- ing after simulation activities. Students readily under- stand the language. During the debriefing, they are able to recognize failures to notice and factors in the situation that may have contributed to that failure (e.g., lack of clin- ical knowledge related to a particular course of recovery, lack of knowledge about a drug side effect, too many inter- ruptions during the simulation that caused them to lose

focus on clinical reasoning). The recognition of reasoning patterns (e.g., hypothetico-deductive patterns) helps stu- dents identify where they may have reached premature conclusions without sufficient data or where they may have leaned toward a favored hypothesis.

Feedback can also be provided to students in debriefing after either real or simulated clinical experiences. A rubric has been developed based on this model that provides spe- cific feedback to students about their judgments and ways in which they can improve (Lasater, in press).

There is substantial evidence that guidance in reflec- tion helps students develop the habit and skill of reflection and improves their clinical reasoning, provided that such

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Educational practices must help students engage with patients and act on a responsible vision for excellent care of those patients and with a deep concern for the patients’ and families’ well-being.

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guidance occurs in a climate of colleagueship and support (Kuiper & Pesut, 2004; Ruth-Sahd, 2003). Faculty have used the Clinical judgment Model as a guide for reflec- tion on clinical practice and report that its use improves students’ reflective abilities (Nielsen, Stragnell, & jester, in press).

Specific clinical learning activities can also be devel- oped to help students gain clinical knowledge related to a specific patient population. Students need help recog- nizing the practical manifestations of textbook signs and symptoms, seeing and recognizing qualitative changes in particular patient conditions, and learning qualitative distinctions among a range of possible manifestations, common meanings, and experiences. Opportunities to see many patients from a particular group, with the skilled guidance of a clinical coach, could also be provided. Heims and Boyd (1990) developed a clinical teaching approach, concept-based learning activities, that provides for this type of learning.

CoNCLusioNs

Thinking like a nurse, as described by this model, is a form of engaged moral reasoning. expert nurses enter the care of particular patients with a fundamental sense of what is good and right and a vision for what makes ex- quisite care. educational practices must, therefore, help students engage with patients and act on a responsible vision for excellent care of those patients and with a deep

CLINICAL jUDGMeNT MODeL

concern for the patients’ and families’ well-being. Clinical reasoning must arise from this engaged, concerned stance, always in relation to a particular patient and situation and informed by generalized knowledge and rational pro- cesses, but never as an objective, detached exercise with the patient’s concerns as a sidebar. If we, as nurse educa- tors, help our students understand and develop as moral agents, advance their clinical knowledge through expert guidance and coaching, and become habitual in reflection- on-practice, they will have learned to think like a nurse.

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Implementation of New Systems

  1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.
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  4. Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling.

Assignment:

Implementation of New Systems

Recorded presentation between 7 and 12 minutes in length. The presentation should include a PowerPoint and oral presentation of the slides. There is no slide number requirement. Answer all questions thoroughly with the allotted time. Be sure to include a title slide, objective slide, content slides, reference slide in APA format. Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly citations to support your claims. This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level. Use a recording platform of your choice and either upload as an mp4 or share the link directly to the video in the dropbox.

You are a project manager assigned to implementing a new computer system in an organization:

  • Why is it important to understand usability, configurability, and interoperability? Should these concepts outweigh the underlining cost of the new system? Which system do you recommend and why?
  • During phase one, you are selecting a team. What characteristics are important to consider when selecting a team?
  • During phase two the following principle was discussed, “lead with culture, determining where the resistance is,” and then, engage all levels of employees (Sipes, 2019, p. 161). What does this principle mean to you and how can you implement this principle?
  • How will you handle physician and other key professionals’ resistance to change and using the new system?
  • Discuss possible pitfalls during the implementation phase and how you can avoid them?
  • Describe your personal experience with automation and new information systems.

Assignment Expectations:

Length: Recorded presentation between 7 and 12 minutes in length. The presentation should include a PowerPoint and oral presentation of the slides. There is no slide number requirement. Answer all questions thoroughly with the allotted time. Use a recording platform of your choice and either upload as an mp4 or share the link directly to the video in the dropbox.

Structure: Include a title slide, objective slide, content slides, reference slide in APA format.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as an mp4 document (.mp4) or share the link to the recording

File name: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.mp4”)

Presentation: Use a presentation software (ex. PowerPoint, Google Slides) to create a visual presentation. Then use a recording program of your choice to record a 7 and 12 minutes in length presentation. ***Please do not record as voice-over PowerPoint because this cannot be saved in mp4 format or a link.*** If you submit your assignment as a PowerPoint with voice over recording you will not receive credit for your assignment (or partial credit as you did not meet the full requirements of the assignment.)

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Opportunity Cost

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Video Discussion 1 – Opportunity Cost

Before completing this graded discussion. You should have full understanding of the concepts below, if you don’t please use the textbook and review them first.

  • Opportunity Cost, Scarcity, Production Efficiency, Allocative Efficiency, Incentives, Human Capital, Specialization, and Comparative Advantage

Instructions and Steps:

1. View the following 3 TED Talks (video presentations). As you watch the videos, take notes of any relevant information.

2. Decide which of the 3 TED Talks best responds to this question;

  • How can identifying your opportunity costs, help you make better choices?

3. Produce a Post of at least 300 words in which you explain your position. Your post must contain at least the following elements:

  • It must state the title and the author of the chosen TED Talk.
  • It must state the reason why believe that TED Talk best answers the question.
  • It must explicitly explain the relationship, connection, or link between the ideas provided in the TED Talk and the concept of Opportunity Cost.

Your grade will be based on how clear, precise, accurate, relevant and logical your post is and if it was turned in on time. Things such as the name of the video, the name of the presenter, your name, the questions, citation, and date do not count towards the word count.

You must start a thread before you can read and reply to other threads

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 Health policy and politics

To prepare:

  • Review Chapter 3 of Milstead, J. A. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington, MA: Jones and Bartlett Publishers.
  • In the first assignment, you reflected on whether the policy you would like to promote could best be achieved through the development of new legislation, or a change in an existing law or regulation. Refine as necessary using any feedback from your first paper.
  • Contemplate how existing laws or regulations may affect how you proceed in advocating for your proposed policy.
  • Consider how you could influence legislators or other policymakers to enact the policy you propose.
  • Think about the obstacles of the legislative process that may prevent your proposed policy from being implemented as intended.

To complete:

Part Two will have approximately 3–4 pages of content plus a title page and references. Part Two will address the following:

  • Explain whether your proposed policy could be enacted through a modification of existing law or regulation or the creation of new legislation/regulation.
  • Explain how existing laws or regulations could affect your advocacy efforts. Be sure to cite and reference the laws and regulations using primary sources.
  • Provide an analysis of the methods you could use to influence legislators or other policymakers to support your policy. In particular, explain how you would use the “three legs” of lobbying in your advocacy efforts.
    • Summarize obstacles that could arise in the legislative process and how to overcome these hurdles.

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parasympathetic nervous system

1. Question: The lung is innervated by the parasympathetic nervous system via which nerve?

2. Question: What is the action of urodilatin?

3. Question: What is the direct action of atrial natriuretic hormone?

4. Question: Which statement best describes a Schilling test?

5. Question: Hemolytic disease of the newborn (HDN) can occur if the mother:

6. Question: Which T-lymphocyte phenotype is the key determinant of childhood asthma?

7. Question: Perceived stress elicits an emotional, anticipatory response that begins where?

8. Question: Hypersensitivity is best defined as a(an):

9. Question: It has been determined that a tumor is in stage 2. What is the meaning of this finding?

10. Question: An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect?

11. Question: Which statement concerning exotoxins is true?

12. Question: The function of the foramen ovale in a fetus allows what to occur?

13. Question: Which laboratory test is considered adequate for an accurate and reliable diagnosis of gonococcal urethritis in a symptomatic man?

14. Question: Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants?

15. Question: Which statement concerning benign tumors is true?

16. Question: Which primary characteristic is unique for the immune response?

17. Question: Which criterion is used to confirm a diagnosis of asthma in an 8-year-old child?

18. Question: Where are antibodies produced?

19. Question: How much urine accumulates in the bladder before the mechanoreceptors sense bladder fullness?

20. Question: Which disorder results in decreased erythrocytes and platelets with changes in leukocytes and has clinical manifestations of pallor, fatigue, petechiae, purpura, bleeding, and fever?

21. Question: Carcinoma in situ is characterized by which changes?

22. Question: What is the life span of platelets (in days)?

23. Question: What is the primary cause of respiratory distress syndrome (RDS) of the newborn?

24. Question: What is the life span of an erythrocyte (in days)?

25. Question: Low plasma albumin causes edema as a result of a reduction in which pressure?

26. Question: Which blood cell type is elevated at birth but decreases to adult levels during the first year of life?

27. Question:  Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)?

28. Question:  Phagocytosis involves neutrophils actively attacking, engulfing, and destroying which microorganisms?

29. Question:  What part of the kidney controls renal blood flow, glomerular filtration, and renin secretion?

30. Question:  The risk for respiratory distress syndrome (RDS) decreases for premature infants when they are born between how many weeks of gestation?

31. Question:  What is the functional unit of the kidney called?

32. Question:  Which hepatitis virus is known to be sexually transmitted?

33. Question: Which statement is true concerning the IgM?

34. Question: Apoptosis is a(an):

35. Question: What are the abnormalities in cytokines found in children with cystic fibrosis (CF)?

36. Question: Research supports the premise that exercise has a probable impact on reducing the risk of which cancer?

37. Question: Why is nasal congestion a serious threat to young infants?

38. Question: Between which months of age does sudden infant death syndrome (SIDS) most often occur?

39. Question: In which primary immune deficiency is there a partial-to-complete absence of T-cell immunity?

40. Question: Blood vessels of the kidneys are innervated by the:

41. Question: An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody?

42. Question: Which term is used to identify the movement of gas and air into and out of the lungs?

43. Question: What is the first stage in the infectious process?

44. Question: What process allows the kidney to respond to an increase in workload?

45. Question: Which congenital heart defects occur in trisomy 13, trisomy 18, and Down syndrome?

46. Question: What is the trigone?

47. Question: The coronary ostia are located in the:

48. Question: What is the chief predisposing factor for respiratory distress syndrome (RDS) of the newborn?

49. Question: The most common site of metastasis for a patient diagnosed with prostate cancer is which location?

50. Question: Which of the following is classified as a megaloblastic anemia?

51. Question: The glomerular filtration rate is directly related to which factor?

52. Question: In a normal, nonmutant state, an oncogene is referred to as a:

53. Question: What is the most common cause of iron deficiency anemia (IDA)?

54. Question: What effect do natriuretic peptides have during heart failure when the heart dilates?

55. Question: What is the major concern regarding the treatment of gonococci infections?

56. Question: Immunoglobulin E (IgE) is associated with which type of hypersensitivity reaction?

57. Question: Which cytokines initiate the production of corticotropin-releasing hormone (CRH)?

58. Question: What is the primary site for uncomplicated local gonococci infections in men?

59. Question: Continuous increases in left ventricular filing pressures result in which disorder?

60. Question: Where in the respiratory tract do the majority of foreign objects aspirated by children finally lodge?

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