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What is the difference between a protocol, standard of care delivery, and policy at the practice, state, and federal level? Briefly outline each. What are the perceptions of the health care delivery system from the perspectives of patients, providers, payers, and policy makers? Discuss at least one perception from one of the populations listed: patient, provider, payer, and policy maker. 

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What is the difference between a protocol, standard of care delivery, and policy at the practice, state, and federal level? Briefly outline each. What are the perceptions of the health care delivery system from the perspectives of patients, providers, payers, and policy makers? Discuss at least one perception from one of the populations listed: patient, provider, payer, and policy maker.

Protocol:

A protocol in healthcare refers to a set of guidelines or predetermined steps that dictate how specific medical procedures, tests, or treatments should be carried out. Protocols ensure consistency and safety in healthcare practices. They provide a systematic approach for healthcare providers to follow in various clinical situations.

 

Standard of Care Delivery:

The standard of care delivery represents the accepted level of care that a competent healthcare provider would deliver in a given situation. It is based on current medical knowledge, practices, and ethical standards. The standard of care varies based on the condition, patient’s needs, and the resources available.

 

Policy:

Healthcare policies are rules, regulations, and guidelines established at different levels (practice, state, federal) to govern various aspects of healthcare delivery, such as patient care, insurance coverage, reimbursement, and healthcare administration. Policies are designed to ensure the efficient and effective functioning of the healthcare system.

 

Perceptions of the Healthcare Delivery System:

 

Patient Perspective:

Patients often value accessibility, quality of care, effective communication with providers, and affordability. They desire timely appointments, clear explanations of their conditions, and personalized treatment plans. Patients may also be concerned about insurance coverage and out-of-pocket costs.

 

Provider Perspective:

Healthcare providers aim to provide high-quality care while managing heavy workloads and administrative tasks. They value patient outcomes, evidence-based practices, and a supportive work environment. Providers may be frustrated with bureaucratic processes and the pressure to balance time constraints with delivering optimal care.

 

Payer Perspective:

Payers, which include insurance companies and government programs, are focused on controlling costs while ensuring patients receive necessary care. They seek to balance the financial sustainability of healthcare systems with the coverage and benefits they offer to patients.

 

Policy Maker Perspective:

Policy makers are concerned with creating and implementing regulations that promote public health, safety, and equitable access to care. They must navigate complex healthcare dynamics, including funding allocation, regulatory compliance, and stakeholder interests.

 

Example Perception: Provider Perspective – Burnout:

From the provider perspective, burnout has become a significant concern. Many healthcare providers experience burnout due to the demanding nature of their work, administrative burdens, long hours, and the emotional toll of dealing with patient suffering. This perception highlights the need for healthcare policies that address provider well-being, work-life balance, and support systems to maintain a motivated and healthy healthcare workforce.

 

It is worth noting that these perspectives and perceptions can evolve over time and may vary based on cultural, regional, and systemic factors.

 

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Select an active bill at the state or federal level that impacts the professional practice of nursing.  summarize the provisions of the bill and clearly explain what the bill will accomplish. 

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Select an active bill at the state or federal level that impacts the professional practice of nursing.  summarize the provisions of the bill and clearly explain what the bill will accomplish.

  • Discuss the major provisions of the bill.
  • Demonstrate an in-depth understanding of the legislation by explaining the background and all relevant facts.
  • Discuss any relevant history related to the legislation, pertinent votes, and issues that are stalling the legislation, etc.
  • Use primary sources for this information.
  • Identify key supporters and those who do not support the bill. Explain why some of these individuals support the bill and why some do not.
  • Explore the positions of the key stakeholders in the bill, both pros and cons. Do not make assumptions about potential key stakeholders. Examine this area carefully so you are correctly reflecting the stakeholders positions.
  • Discuss how the bill would impact a nurse’s ability to provide safe and quality care or to practice to the highest scope of the nursing license.
  • Explain specific actions that nurses can take to assist with the passage or defeat of the legislation
  • Use Current APA Style, headings and references as appropriate.
 

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The nurses assessment of a community dwelling adult suggest that the client may have drug allergies that have not been previously documented. What statements by the client would confirm this? A. I tend to get sick in the stomach when I take antibiotics B. I’ve been told that aspirin might have caused my stomach bleed a few years back C. I broke out in hives and got terribly itchy when I started a new prescription last year D. When I fell last year, the doctor said that it might have been because of my blood pressure pills C. I broke out in hives and got terribly itchy when I started a new prescription last year13.

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1. The nurse has been assigned to care for a 52-year-old attorney who has hypertension and peptic ulcer disease. Before administering his medications, the nurse must complete an initial assessment. Core patient variables Will be obtained from which of the following? (Select all that apply)

A. The interview
B. The patient’s medical history
C. The patient’s medical record
D. The patient’s physical examination
E. The patient’s health insurer

A, B, C, and D
2. 68-year-old female patient who was diagnosed with hypertension two weeks ago and was prescribed a new hypertension medication has returned to the clinic for follow-up. Nurse notes that patient’s blood pressure is unchanged from her last visit. When patient was asked if she was taking the new medication on a regular basis, she stated, “I thought that I was supposed to take the new drug when I had a pounding headache or was in a stressful situation, not all the time.” An appropriate nursing diagnosis for this patient would be which of the following?
A. Knowledge deficit due to the lack of understanding of treatment regimen
B. Coping -ineffective due to forgetfulness
C. Confusion -acute concerning drug administration
D. Anxiety due to diagnosis of hypertension
A. Knowledge deficit due to the lack of understanding of treatment regimen
3. In order to promote therapeutic drug effects, the nurse should always encourage patients to:
A. Take their medication with meals
B. Take their medication at the prescribed times
C. Increased medication dosage if necessary
D. Use alternative therapy to increase the effects of their medications
B. Take their medication at the prescribed times
4. The patient is treated with an anabiotic for an infection in his leg. After two days the patient called the clinic and reports a rash over his body. The nurse is aware that a rash can be an adverse effect of an anabiotic and can either be biological, chemical, or physiologic action of the drug. This is an example of:
A. Pharmacotherapeutics
B. Pharmacokinetics
C. Pharmacodynamics
D. Pharmacogenetics
C. Pharmacodynamics
5. A nurse has been assigned the task of preparing educational materials for a patient with diabetes. This includes the drug name, the reason the drug was prescribed, the intended effect of the drug, along with important adverse effects that should be reported to the nurse or healthcare provider. Which of the following information is essential to include in the educational materials?
A. Drug administration method
B. Core drug knowledge
C. Vital signs of the patient
D. Diagnosis and outcome identification mechanism
A. Drug administration method
6. 56-year-old female has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfume. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction?
A. Call the doctor immediately regarding her allergic reactions
B. Hold the medication for her muscle spasms until she can be treated for a possible allergic reaction
C. Post and allergies notice on the front of her chart and document the allergies in the appropriate area of the electronic medical record
D. Call the dietary staff and make sure that the patient has not served eggs for breakfast
C. Post an allergies notice on the front of the chart and document the allergies in the appropriate area of the electronic medical record
7. The nurse has been assigned a 49-year-old patient who has acute colitis, and the nurse just completed gathering data concerning core drug knowledge and core patient variables. To implement nursing management of drug therapy for this patient, the nurse will then
A. Evaluate the outcome of drug therapy
B. Devise strategies to maximize the therapeutic effects of the drug
C. Implement planned nursing actions
D. Assess for data that will indicate interactions between core drug knowledge and core patient variables
B. Device strategies to maximize the therapeutic effects of the drug
8. Which of the following activities with the nurse expect to complete during the evaluation phase of the nursing process and drug therapy?
A. Compare the outcome expected with the actual patient outcome
B. Reconsider core drug knowledge and core patient variables
C. Ask questions to prepare an effective patient education program
D. Establish a baseline for the patient’s treatment and care
A. Compare the outcome expected with the actual patient outcome
9. A nurse is caring for a post surgical patient who has small tortuous veins and had a difficult IV insertion. The patient is now receiving IV medications on a regular basis. What is the best nursing intervention to minimize the adverse effects of this drug therapy?
A. Monitor the patient’s bleeding time
B. Check the patient’s blood glucose levels
C. Record baseline vital signs
D. Monitor the IV site for redness, swelling, or pain
D. Monitor the IV site for redness, swelling, or pain
10. Patient has been prescribed several drugs and fluids to be given IV. Before the nurse start the IV administration, a priority assessment of the patient will be to note the
A. Heart rate
B. Body weight and height
C. Blood pressure
D. Skin surrounding the potential IV site
D. Skin surrounding the potential IV site
11. A nurse is performing an admission assessment of an elderly patient being admitted to a medical ward from the emergency department. Which of the following is an open ended assessment question?
A. Have you ever had a bad response to a drug you’ve taken?
B. Does anyone in your immediate family have a history of drug allergies?
C. Are you comfortable with receiving needles?
D. What kind of reactions have you had to medications?
D. What kind of reactions have you had to medications?
12. The nurses assessment of a community dwelling adult suggest that the client may have drug allergies that have not been previously documented. What statements by the client would confirm this?
A. I tend to get sick in the stomach when I take antibiotics
B. I’ve been told that aspirin might have caused my stomach bleed a few years back
C. I broke out in hives and got terribly itchy when I started a new prescription last year
D. When I fell last year, the doctor said that it might have been because of my blood pressure pills
C. I broke out in hives and got terribly itchy when I started a new prescription last year
13. A nurse who provides care on a busy medical unit of a large hospital is constantly faced with new drugs on patient’s medication administration records. What strategy should the nurse employe to foster up-to-date information about the nursing management of new or uncommon drugs?
A. Focus on learning about a prototype drug that is characteristic of a larger drug class
B. Identify similarities between new drugs and older drugs that are commonly used on the unit
C. Commit time and energy during each shift to learning about new drugs
D. Liaise with pharmacist and pharmacy technicians who work at the hospital
A. Focus on learning about a prototype drug that is characteristic of a larger drug class
15. Surgical patient diagnosed with type 2 diabetes during admission to the hospital. The nurse and healthcare team members have attempted to engage the patient in education about his new diagnosis, the effects it will have on his lifestyle, and the medications that will be necessary to treat it. However, the patient is unwilling to discuss these matters, usually siding fatigue or the desire to watch TV or make phone calls. What potential nursing diagnosis should the nurse prioritize?
A. Ineffective coping
B. knowledge deficit
C. Acute confusion
D. Anxiety
A. Ineffective coping
16. A physician has ordered subcutaneous injections of morphine, a narcotic, every four hours as needed for pain for a motor vehicle accident victim. The nurse is aware that there is a high abuse potential for this drug and that is categorized as a
A. C-I drug
B. C-II drug
C. C-III drug
D. C-IV drug
B. C-II drug
17. A nurse working for a drug company is involved in phase III drug evaluation studies. Which of the following month nurse to be responsible for during this stage of drug development?
A. Working with animals who are given experimental drugs
B. Monitoring drug effects in patients who are selected to participate in a study, who may have the disease that the drug is meant to treat
C. Administering investigational drug to patients
D. Informing healthy, young volunteer participants of possible risks that could occur from taking an experimental drug
C. Administering investigational drug to patients
18. Which of the following would be the most user-friendly and appropriate source of drug information for a nurse?
A. Drugs Facts and Comparisons book
B. A nurse’s drug guide
C. The drug package insert
D. The physicians drug reference (PDR)
B. A nurse’s drug guide
19. A nurse works in a private hospital and needs to administer narcotic drugs to one of her patients. Which of the following should the nurse consider when administering narcotics two patients in a hospital setting?
A. Narcotics are banned in private settings and cannot be used
B. Narcotics can be used in the hospital after obtaining a written approval from the joint commission for accreditation of hospitals and healthcare organizations (JCAHO)
C. Narcotics to be used in the hospital are dispensed only with a written prescription
D. Narcotics can be used in the hospital according to the patient preferences
C. Narcotics to be used in the hospital are dispensed only with a written prescription
20. A nurse who is responsible for administering medications should understand that the goals of the MedWatch program are to (select all that apply)
A. Provide regular feedback about product safety issues
B. Accredit new medical facilities and hospitals
C. Facilitate the reporting of adverse drug reactions
D. Increase awareness of serious reactions caused by drugs or medical devices
E. Report medication errors that occur in hospitals
A. Provide regular feedback about product safety issues
C. Facilitate the reporting of adverse reactions of drugs
D. Increase awareness of serious reactions caused by drugs or medical devices
21. A nurse is a member of a research team that is exploring unique differences in responses to drugs that each individual possesses, based on genetic makeup. This area of study is called
A. Pharmacotherapeutics
B. Pharmacodynamics
C. Pharmacoeconomics
D. Pharmacogenomics
D. Pharmacogenomics
22. Which of the following statements best defines how a chemical becomes termed a drug?
A. A chemical must have proven therapeutic value or efficacy without severe toxicity or damaging properties to become a drug
B. A chemical becomes a drug when it is introduced into the body and causes a change
C. I chemical is considered a drug when the FDA approves it’s released to be marketed
D. A chemical must have demonstrated therapeutic value to become a drug
A. I chemical must have a proven therapeutic value or efficacy without severe toxicity or damaging properties to become a drug
23. Which of the following serve to protect the public by ensuring purity of a drug and its contents?
A. American pharmaceutical association
B. United States adopted names counsel
C. Nursing drug guidelines
D. Federal legislation
D. Federal legislation
24. A nurse is providing a patient with a list of drugs as a part of the patient’s plan of care. Which of the following drug nomenclatures should the nurse use to list the drugs?
A. The drugs chemical names
B. The drugs generic names
C. The drug trade names
D. The drugs biologic names
B. The drugs generic names
25. The medication nurse is in charge of transcribing drug orders and administering drugs to assigned patients. While preparing the drugs for administration, the nurse should always check
A. For drug composition
B. The chemical, generic, and trade name of each drug
C. The drug name at least three times-before, during, and after obtaining each drug
D. The cost of each drug
C. The drug name at least three times-before, during, and after obtaining each drug
26. A nurse who provides care in a long-term care facility is documenting a new resident’s medication regimen on the intake admission form. The nurse is documenting the generic, rather than proprietary, names of the resident’s current drugs because
A. There is a potential for confusion and miscommunication if proprietary names are used
B. Proprietary names of drugs can vary from state to state
C. Documentation of trade names for drugs requires permission from the manufacturer
D. Drugs with generic names are prescribed and used differently then proprietary drugs
A. There is a potential for confusion and miscommunication is proprietary names are used
28. A nurse and a large university hospital has been informed that a drug trial will be taking place that may involve several patients in the hospital over the next several months. What is the nurse’s most likely role in this drug testing process?
A. Determining the clinical efficiency and safety of the drug
B. Suggesting potential improvements to the testing process
C. Administering the investigational drug to patients
D. Consulting on the methodology that has been chosen for testing the drug
C. Administering the investigational drug two patients
29. A nurse is performing discharge teaching with a patient who will be returning home shortly after being diagnosed with type two diabetes. The patient has stated that his intention to purchase his medications from an online pharmacy in an effort to save money. How should the nurse best respond to the patient’s statement?
A. Using an online pharmacy is an excellent way to reduce your drug costs
B. If you do this, make sure that the pharmacy is physically located in the United States
C. Be very careful when doing this, and make sure you’re in close contact with your physician
D. Actually, obtaining prescription drugs via the Internet has recently been made illegal
C. Be very careful when doing this, and make sure you’re in close contact with your physician
30. A patient with recent history of acute pain has been transferred to the intensive care unit after the nurse mistakenly administered hydromorphone rather than morphine. Which of the following statements best describes the legal responsibility of nurses when administering drugs?
A. Liability insurance protects nurses from litigation related to drugs
B. Physicians are ultimately responsible for drug errors that occur in hospital settings
C. Nurses have an ethical, but not legal, responsibility to give drugs safely
D. Nurses are legally responsible for safe drug administration
D. Nurses are legally responsible for safe drug administration
31. Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the Talwin. This drug interaction affecting the pharmacodynamics of Talwin is
A. additive effect
B. Synergistic effect
C. Potentiated effect
D. Antagonistic effect
D. Antagonistic effect
32. On the 1am rounds, The nurse finds a patient awake and frustrated that she cannot go to sleep. The nurse administers and ordered hypnotic to allow the patient to sleep. Two hours later, the nurse finds the patient out of bed, full of energy, and cleaning her room. The nurse evaluates the patient’s response to the hypnotic as
A. Allergic reaction
B. Idiosyncratic response
C. Synergistic effect
D. Teratogenic effect
B. Idiosyncratic effect
34. The nurse is caring for a patient who has recently moved from Vermont to South Florida. The patient has been on the same antihypertensive drugs for six years and has had stable blood pressures with no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. The nurses specs that the change in the effectiveness of the drug is related to
A. The impact of the placebo effect on the patient’s response
B. The accumulative affect of the drug if it is been taken for many years
C. The impact of the warmer climate on the patient’s physical state
D. Problems with patient compliance with the drug regimen due to the move
C. The impact of the warmer climate on the patient’s physical state
35. A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety?
A. A list of pharmacies where the drug can be obtained
B. Measures to alleviate any discomfort associated with adverse effects
C. The cost of the brand drug compared with the generic form
D. Statistics related to phase III of drug testing for the prescribed drug
B. Measures to alleviate any discomfort associated with adverse effects
36. A nurse is caring for a patient who is experiencing nausea and vomiting from chemotherapy. Which of the following would be an appropriate nursing diagnosis for this patient?
A. Infection-risk for related to drug induced bone marrow suppression
B. Nutrition-imbalanced: less than body requirements related to adverse effects of drug
C. Poisoning-risk for related to use of drug with narrow therapeutic index
D. Nutrition-imbalanced: more than body requirements related to adverse effects of drug
B. Nutrition-imbalanced: less than body requirements related to adverse effects of drug
37. A nurse has administered a medication to a patient with hypertension. The prescribed a drug is supposed to decreased cardiac output. A decrease in cardiac output would most likely
A. Increase the serum creatinine level
B. Decrease drug absorption in the blood
C. Decrease the amount of circulating blood sent through the kidneys
D. Increase the synergistic effect of the drug
C. Decrease the amount of circulating blood sent through the kidneys
38. A home health nurse notes that there have been changes to the patient’s oral drug regimen. The nurse will closely monitor the new drug regimen to
A. Track the exact route of metabolism as a research project
B. Identify any changes in drug absorption that would change the drug effect
C. Monitor only for the adverse effect of immunotoxicity
D. Determine the speed of chelation
B. Identify any changes and drug absorption that would change the drug effect
39. Which of the following affects drug distribution throughout the body?
A. Presence of food in the gastrointestinal tract
B. Increase in hepatic enzymes
C. Protein binding
D. High blood levels
C. Protein binding
40. The patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of pain medication is given, The patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is
A. Hepatotoxic response
B. Idiosyncratic response
C. Paradoxical response
D. Allergic response
D. Allergic response
41. A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man’s most recent visit to his provider, routine bloodwork was ordered and the results indicated a rise in his serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings?
A. The man may be experiencing a paradoxical effect of aspirin
B. The man may be allergic to aspirin
C. The man may be experiencing liver toxicity from aspirin
D. The man may be experiencing nephrotoxic effects of aspirin
D. The man may be experiencing nephrotoxic effects of aspirin
42. A nurse who provides care for older adults is aware of the high incidence of drug interactions in this population. When educating a group of seniors about the prevention of drug interactions, the nurse should encourage them to
A. Take their medications with food unless otherwise instructed
B. Consult their care provider before taking new over-the-counter medications
C. Maintain a healthy, high fluid diet, and high levels of physical activity
D. Ensure that there is at least 90 minutes between doses of different drugs
B. Consult their care provider before taking new over-the-counter medications
43. A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient’s medication regimen. Which of the patient’s medications should prompt the nurse to teach her to avoid drinking grapefruit juice?
A. Atorvastatin (Lipitor)
B. Rabeprazole (Aciphex)
C. Vitamin D
D. Citalopram (Celexa)
A. Atorvastatin (Lipitor)
44. In light of her recent high blood pressure readings, patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address patient hypertension?
A. The adverse effects of each drug may cancel each other out
B. Using to drugs for a health problem tends to increase patient compliance with the drug regimen
C. Using lower doses of two separate drugs may lessen the risk of adverse reactions
D. Using the two drugs to treat a health problem may create a synergistic effect
D. Using the two drugs to treat a health problem may create a synergistic effect
45. A hospital patient has been prescribed an anti-emetic and an antibiotic, both of which are to be administered intravenously. What action should the nurse prioritize before administering the drugs using the same tubing?
A. Warn the patient about the possibility of idiosyncratic drug effects
B. Assess the possibility that the antibiotic is causing the patients nausea
C. Check the compatibility of the two drugs
D. Review the patient’s most recent bloodwork
C. Check the compatibility of the two drugs
46. A nurse is caring for a patient who abuses marijuana. The treatment for marijuana abuse consists mainly of
A. Nonpharmacologic interventions combined with an exercise program
B. Drug therapy with bromocriptine (Parlodel)
C. Aggressive respiratory assistance
D. No nursing action unless the patient experiences a “bad trip”
A. Nonpharmacologic interventions combined with an exercise program
47. A nurse is working in the emergency department and is assigned to a patient brought in by family members. The family thinks that the patient is on methamphetamine. Which of the following will the nurse assessed for?
A. Increased appetite
B. Hypertension
C. Bradycardia
D. Stupor
B. Hypertension
48. The patient comes to the clinic asking for help to quit drinking alcohol. She has a 21 year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cost which of the following?
A. Bradycardia
B. Diarrhea
C. Nausea
D. Slight headache
C. Nausea
49. The patient has been admitted to the hospital with acute cocaine intoxication. Family members are present and or observing prolonged seizure activity. The family is upset and asked how long the patient was experiencing seizures. An appropriate response by the nurse would be
A. Not long, he should be fine in a few minutes
B. It’s very hard to tell, but seizure activity might not in right away
C. It is possible that the seizure activity could last a week or more
D. Once a person has had a seizure there is always the possibility of other seizures
B. It’s very hard to tell, but seizure activity my not in right
50. A Native American man is admitted to the emergency department exhibiting a red in the face and an increased heart rate. He reports that he does not normally drink alcohol but at a party had a punch that contain vodka. The nurse recognizes that this reaction may be related to the ethanol exposure and caused by
A. Retarded absorption from the small intestine
B. Immediate distribution at the rate proportional to blood flow and water content
C. Metabolism using the enzyme alcohol dehydrogenase
D. Deficiency in the enzyme aldehyde dehydrogenase
D. Deficiency in the enzyme aldehyde dehydrogenase
51. A nurse is caring for a patient who has been admitted with acute cocaine intoxication. Which of the following vital signs with the nurse expect to find initially when assessing the patient?
A. Blood pressure: 98/50, pulse: 120, respirations: 40
B. Blood pressure: 130/88, pulse: 92, respirations: 28
C. Look pressure: 150/90, pulse: 80, respirations: 16
D. Blood pressure: 170/98, pulse: 110, respirations: 20
D. Blood pressure: 170/98, pulse: 110, respirations: 20
52. A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that he or she is taking an oral form of
A. Methamphetamine
B. Cocaine
C. Marijuana
D. Nicotine
C. Marijuana
53. The patient is suffering from acute inhalant intoxication. The priority nursing intervention will be to
A. Administer epinephrine
B. Administer oxygen therapy
C. Provide and emesis basin
D. Assess the patient’s psychosocial status
B. Administer oxygen therapy
54. A nurse is caring for an adolescent who has a history of alcohol abuse. In order to develop the care plan for this patient, the nurse will need to explore and assess which of the following risk factors? (Select all that apply)
A. Low self-esteem
B. Divorced parents
C. Financial problems
D. Health concerns
E. Depression
A. Low self-esteem
B. Divorced parents
E. Depression
55. The patient has been hospitalized for treatment of substance abuse after being arrested and jailed for the past 24 hours. The patient is experiencing severe muscle and abdominal cramps, seizures, and acute psychosis do too abrupt withdrawal. Which of the following drug classes is the most likely cause of these severe and potentially fatal withdrawal symptoms?
A. Amphetamines
B. Sedative-hypnotic drugs
C. Benzodiazepines
D. Opioids
B. Sedative-hypnotic drugs
56. A 26-year-old professional began using cocaine recreationally several months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he first use the drug. The nurse should recognize that this pattern exemplifies
A. Drug tolerance
B. Addiction
C. Dependence
D. Withdrawal
A. Drug tolerance
57. A 33-year-old man has been a chronic abuser of alcohol for several years and has been admitted to the emergency department many times because of the consequences of his alcohol use. Most recently, he has been brought in by emergency medical services after being found unconscious outside a local mall. The nurse who is admitting the patient should prioritize what assessments?
A. Assessing the patients pattern of dependence and coping strategies
B. Assessing Neurological status and assessing for electrolyte in balances
C. Assessing for Impaired nutrition
D. Assessing for possible interactions between alcohol and other drugs
B. Assessing neurological status and assessing for electrolyte imbalances
58. Paramedics have brought a patient to the emergency department with a suspected heroin overdose. The nurse should recognize that the patients most acute threat to help at this time is
A. Hypokalemia or hyponatremia
B. Acute gastrointestinal bleed
C. Increased intracranial pressure
D. Respiratory depression
D. Respiratory depression
59. A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of the students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?
A. Most people don’t know that marijuana can be just as addictive as heroin or cocaine overtime
B. Marijuana can easily interact with other drugs and cause potentially fatal reactions
C. Every year, thousands of Americans end up in emergency rooms with marijuana overdoses
D. Smoking marijuana is just as bad, or worse, for your lungs and smoking cigarettes
D. Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes
60. A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiological effect of cocaine use during pregnancy?
A. Changes in blood chemistry as a result of nephrotoxicity and hepatotoxicity
B. Impaired maternal nutrition as a result of drug use
C. Vasoconstriction leading to reduced placental blood flow
D. Hypoxia as a result of prolonged second stage of labor
C. Vasoconstriction leading to reduced placental blood flow
61. A new immigrants to the United States has come to the clinic. She reports having lived in a crowded, poor urban area. Considering her residence and immigration status, which of the following should the nurse screen for?
A. Tuberculosis
B. Malaria
C. Diabetes
D. Hypertension
A. Tuberculosis
63. A nurse is assigned to a Caucasian patient who has a phenotype in which the CYP2D6 gene is duplicated. In order to plan appropriate care with regard to drug therapy the nurse is aware that the patient would
A. Exhibit no change in metabolic activity through the CYP2D6 pathway
B. Metabolize drugs poorly through the CYP2D6 pathway
C. Exhibit reduced CYP2D6 activity
D. Exhibit ultra-rapid metabolism through the CYP2D6 pathway
D. Exhibit ultra-rapid metabolism through the CYP2D6 pathway
65. A nurse is caring for a middle-aged man of Navajo Indian origin who has type two diabetes and who is living a traditional Navajo lifestyle. The nurse will be sure to discuss the adverse effects of drug therapy with which of the following family members?
A. Patients father
B. The patient’s spouse
C. The patients grandmother
D. The patients grandfather
C. The patients grandmother
66. A 32-year-old Asian female Who just arrived in the United States has been diagnosed with hypertension. She has come to the clinic for an office visit and states that she has always used “traditional healing preparations” when ill. In discussing her new antihypertensive drugs, the nurse will assess her use of
A. Analgesics
B. Diuretics
C. Ginseng
D. Antidepressants
C. Ginseng
67. A Hispanic woman is hospitalized for complications of type one diabetes. The nurse speaks only English; the patient only understands Spanish. The patient is being discharged from the hospital, and the nurse needs to provide education related to her diabetes. However, the discharge instructions are in English. The nurse should use
A. Body language to educate her and then give her the discharge instructions
B. An interpreter to educate her and then give her the English version of the discharge instructions, so she can begin to learn the language
C. A translator to translate the material and give them to her
D. An interpreter to review the discharge instructions with the patient and then give her the printed material translated into Spanish
D. An interpreter to review the discharge instructions with the patient and then give her the printed material translated into Spanish
68. A 46-year-old white American has been prescribed a drug that binds to acid glycoproteins. The nurse understands that white Americans usually receive
A. A higher-than-normal dose of drugs that bind to acid glycoproteins
B. A lower-than-normal dose of drugs that bind to acid glycoproteins
C. They recommended normal dose of drugs that bind to acid glycoproteins
D. One half the recommended dose of drugs that bind to acid glycoproteins
A. A higher-than-normal dose of drugs that bind to acid glycoproteins
69. A nurse is admitting a Mexican woman to the hospital who cannot speak or understand English. The patient is alone, and there is no interpreter available. When trying to communicate with the patient the nurse will
A. Speak loudly
B. Exaggerate her mouth movements
C. Use nonverbal language
D. Speak fast
C. Use nonverbal language
70. A Native American man who lives a traditional lifestyle is scheduled to have heart surgery. The tribal chief has requested that the tribes medicine man perform a ritual before the patient goes to surgery. The nurses response to this request should be
A. I’m sorry, but that will not be possible
B. I will need to inform the doctor and see if he will allow this
C. As long as the ritual does not interfere with the patients preoperative care, it will be OK
D. I don’t think that will help, but you have the right to perform the ritual
C. As long as the ritual does not interfere with the patient preoperative care, it will be OK
71. A nurse is providing care for a 71-year-old woman who was sponsored to emigrate from Mexico to the United States six months ago. Earlier this week, the woman slipped while getting off a buzz and fractured her hip. How should the woman’s nurse best exemplify cultural competence in the care of this patient?
A. Ensure that the woman receive care solely from Spanish-speaking caregivers
B. Consider dimensions of the woman’s cultural background when planning care
C. Integrate teaching about American culture when interacting with the patient
D. Address the woman’s children first when explaining her care and changes in her health status
B. Consider dimensions of the woman’s cultural background when planning care
72. The nurse who is employed by a large, multinational pharmaceutical company is a member of an interdisciplinary research team that is focused on pharmacogenomic research. What research question is most closely aligned to this team’s probable mandate?
A. How can we integrate cultural beliefs and preferences into drug therapy?
B. How can we use pharmaceuticals in an effort to improve the human genome?
C. How can we best treat the diseases that are known to be more prevalent in certain groups?
D. How can we customize drugs to be especially effective for particular individuals and groups?
D. How can we customize drugs to be especially effective for particular individuals and groups?
73. A nurse is aware of the concepts of genotype and phenotype I must be included in any consideration of pharmacogenetics. Which of the following statements is true of these concepts?
A. Genotype is an expression of DNA, but phenotype is a cultural concepts
B. Genotype is easily modifiable, but phenotype is not modifiable
C. Genotype is a consequence of the genetic makeup of an individual’s parents while phenotype is unique to every individual
D. Genotype is the composition of a person’s DNA, but phenotype is the manifestation of these genes
Genotype is the composition of a person’s DNA, but phenotype is the manifestation of these genes
74. Genetic testing has revealed that a woman of European origin lacks CYP2D6 activity. This fact is likely to have an influence on which aspect of pharmacokinetics?
A. Excretion
B. Distribution
C. Metabolism
D. Absorption
C. Metabolism
75. A 60-year-old African-American man lives with a number of chronic health problems. Genetic factors are likely to influence his etiology and/or treatment of
A. Hypertension
B. Low bone density
C. A seizure disorder
D. Cardiac arrhythmias
A. Hypertension
76. Which of the following patients should be advised that the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?
A. A 47-year-old woman with hypertension
B. A 52-year-old man with adult onset diabetes
C. A 17-year-old girl with symptoms of an upper respiratory infection
D. 62-year-old man with gout
A. A 47-year-old woman with hypertension
77. And nurse received an order for clonidine (Catapres) for a man who has been diagnosed with secondary hypertension. Which of the following would be the most appropriate action by the nurse?
A. Weigh the patient to get the correct body surface area
B. Had a second nurse check the dance before administering the drug
C. Question the order because the patient is not receiving any other antihypertensives
D. Make sure the patient is on a cardiac monitor
C. Question the order because the patient is not receiving any other antihypertensives
78. A nurse is caring for a patient who is taking metoprolol (Lopressor). Which of the following statements would indicate that teaching about a nurse concerning the beta-adrenergic antagonist has been effective?
A. I may have a very dry mouth while taking this drug
B. I should never stop taking this drug abruptly
C. I can stop walking a mile a day
D. Since I am taking this drug, I no longer need to worry about my diet
B. I should never stop taking this drug abruptly
79. A priority nursing assessment for a patient who is receive an alpha-or beta-adrenergic antagonist would be to
A. Assess heart rate
B. Check blood glucose level
C. Measure urine output
D. Monitor respiratory rate
A. Assess heart rate
80. A 70-year-old man with diabetes mellitus is taking the my metoprolol (Lopressor) to manage his hypertension. The nurse would be sure to instruct the patient to
A. Take his pulse at least four times a day
B. Wait himself once a week at the same time of the day
C. Avoid smoke-filled rooms
D. Understand the signs and symptoms of hypoglycemia
D. Understand the signs and symptoms of hypoglycemia
81. The patient is experiencing a serious allergic reaction to a bee sting is brought to the emergency department. The patient’s right hand is swollen, red, and painful. She is extremely upset, shortbread, and the nurse to text wheezing and stridor. The nurses order to administer epinephrine to relieve the patient’s
A. Pain and swelling around the sting site
B. Discoloration in her hand
C. Acute anxiety
D. Acute bronchospasm
D. Acute bronchospasm
82. A nurse in the intensive care unit is caring for a patient in shock and has started IV administration of dopamine (Inotropin). For a patient in shock, domain helps to
A. Decrease heart rate
B. Decrease blood pressure
C. Increase blood pressure
D. Increase body temperature
C. Increase blood pressure
83. The patient is prescribed regular doses of epinephrine. Which of the following nursing diagnoses is related to comfort and would be most appropriate for this patient?
A. Imbalance nutrition: less than body requirements
B. Disturbed sleep pattern, insomnia related to CNS excitation
C. Disturbed sensory perception
D. Ineffective tissue perfusion
B. Disturbed sleep pattern, insomnia related to CNS excitation
84. A man with a history of cardiac arrhythmias is taking metoprolol (Lopressor) 25 mg, three times a day. He calls the clinic at 11 AM and reports that he failed to take his 8 AM dose and his next dose is due at 2 PM. What should the nurse instructed to do?
A. Take two doses when the next dose is due at 2 PM
B. Take two doses as soon as possible
C. Take the missed dose as soon as possible
D. Skip the missed dose and return to the regular dose at 2 PM
D. Skip the missed dose and return to the regular dose at 2 PM
85. A nurse is caring for a patient in the critical care unit. Phentolamine (Regitine, OraVersa). Has been ordered for the management of tissue necrosis caused by extravasation of parenterally administer drugs. Before administering this drug, the nurse will check the patient’s chart for indications of
A. Peptic ulcer disease
B. History of Acute myocardial infarction
C. Diabetes mellitus
D. Obesity
B. A history of acute myocardial infarction
86. Patient has recently been prescribed a drug that treats hypertension but blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of
A. An adrenergic antagonist
B. An adrenergic agonist
C. A cardiotonic
D. A neurotransmitter
A. An adrenergic antagonist
87. A 21-year-old man experience massive trauma and blood loss during a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what assessment should the care team prioritize?
A. Respiratory assessment
B. Arterial blood gases
C. Monitoring of intracranial pressure
D. Cardiac monitoring
D. Cardiac monitoring
88. A 73-year-old man was diagnosed with Parkinson’s disease earlier this year and has been taking carbidopa-levodopa four times daily in an effort to control the signs and symptoms of the disease. The nurse should recognize that this therapeutic effect is achieved by influencing the
A. Uptake of acetylcholine
B. Dopamine receptors in the brain
C. Synthesis of epinephrine
D. Sensitivity of beta-2 receptors
B. Dopamine receptors in the brain
89. A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments?
A. Oxygen saturation and respiratory rate
B. Heart rate and blood pressure
C. Level of consciousness and pain level
D. Temperature and respiratory rate
B. Heart rate and blood pressure
91. The patient is on the surgical floor and is NPO with a TPN infusion and a schedule for abdominal surgery later in the day. A preoperative anabiotic is ordered. To save time, the nurse added the anabiotic solution to a pre-mixed bag of TPN that is infusing. Which complication may result from this drug mixture?
A. A cloudy appearance in the IV line with infusion
B. Burning and redness at the IV site
C. Increased blood loss intraoperatively
D. A pH change and inactivation of the antibiotic
D. A pH change and inactivation of the antibiotic
92. A male patient states that the medications for his blood sugar do not seem to be working. The patient reports that he always takes his medications with food each night because it makes him have nausea without food. Which advice can the nurse provide the patient about taking pills with a full stomach?
A. Every medication should be taken with food to reduce adverse effects from the drug
B. Gastric emptying can occur as soon as 10 minutes after the meal, and he can take the medications then
C. Many medications are in active if the pH in the stomach is too high and prevents excretion
D. Food can delay or reduce the absorption of oral drugs, and some require an empty stomach to facilitate absorption
D. Food can delay or reduce the absorption of oral drugs, and some require an empty stomach to facilitate absorption
93. A male patient is prescribed oral morphine for chronic degenerative disc disease until the scheduled back surgery the following week. Which combination with morphine could be fatal because of the synergistic effect of CNS depression?
A. Morphine and antidepressants
B. Morphine and Pepcid
C. Morphine and Percocet
D. Morphine and tobacco use
C. Morphine and Percocet
94. A 50-year-old female patient with type 2 diabetes and hyperlipidemia schedules an appointment with her primary care provider. Her A1C is 7% and there are no indications of any complications of her diabetes. Her only income is a monthly disability check. Her medications include: Metformin 1000 mg PO daily, lisinopril 5 mg PO daily, aspirin 81 g PO daily, vitamin D 500/200 tab with meals, pravastatin 40 mg PO bedtime, niacin 500 mg PO bedtime, TriCor 145 PO bedtime, FeSO4 325 mg PO daily, Sudafed 12 hour PO daily, Cetrizine. 10 mg PO daily, Bee pollen one capsule daily, cinnamon capsule one with each meal. Which problem could be occurring with this patient related to her medication?
A. Polypharmacy
B. Major adverse drug interactions
C. Overuse of over-the-counter medications
D. Inappropriate prescriptions
A. Polypharmacy
95. A 50-year-old female patient with type 2 diabetes and hyperlipidemia schedules an appointment with her primary care provider. Her A1C is 7% and there are no indications of any complications of her diabetes. Her only income is a monthly disability check. Her medications include: Metformin 1000 mg PO daily, lisinopril 5 mg PO daily, aspirin 81 g PO daily, vitamin D 500/200 tab with meals, pravastatin 40 mg PO bedtime, niacin 500 mg PO bedtime, TriCor 145 PO bedtime, FeSO4 325 mg PO daily, Sudafed 12 hour PO daily, Cetrizine. 10 mg PO daily, Bee pollen one capsule daily, cinnamon capsule one with each meal. The PCP notes that the patient’s blood pressure is 130/90 and orders Accuretic 10/12.5 mg PO daily. The PCP gives the prescription to the nurse. Which action should the nurse take?
A. Reassess the blood pressure before giving the medication
B. Instruct the patient that the medication is for blood pressure
C. Question the order that the patient takes her medications
D. Teach the patient to take the medication in the morning since it contains a diuretic
C. Question the order that the patient takes her medications
96. A nurse practitioner is participating on a committee to help decrease drug misuse and abuse in the free clinic where she works. Patients who are “drug seeking” for narcotics are the most prevalent problem. The nurse practitioner knows that the prevalence of drug seeking and clinics is likely a result of which act that prohibits Internet sales of narcotics?
A. Alger Hiss act
B. Ryan Haight act
C. James Zardroga Act
D. Volstead ctA
B. Ryan Haight Act
98. An 82-year-old patient presents to the clinic today for a routine appointment and prescription refills. She states that she has been having dry mouth and constipation since adding Ditropan to her regimen including Benadryl and several other medications. What role does polypharmacy have in this patient’s complaints?
A. The patient is not following the dosing, which is causing the side effects
B. The patient is purchasing drugs from two different pharmacies and getting different concentrations
C. The drugs are interacting and potentiating the anti-cholinergic side effects
D. The drugs should not be prescribed simultaneously and are counteracting each other
C. The drugs are interacting and potentiating the anti-cholinergic effects
99. A 56-year-old female patient is in the clinic because she needs some prescription refilled. The patient mentions that she would also like to take garlic and St. John’s wort to improve her health. What should the nurse teach the patient about herbals?
A. Education about herbals is not within the scope of the APN
B. Herbals are harmless and safe to use because they are made from plants
C. Herbals can have interactions with prescribed medications
D. Herbals or researched and approved by the FDA
C. Herbals can have interactions with prescribed medications
100. A 56-year-old male morbidly obese patient with a 40 year history of smoking is in the clinic. The patient is short of breath when asking his medication questions and is not able to sit in the patient chair due to body size. What will increase the APN’s effectiveness of medication education?
A. Utilizing the teacher-back method to ensure the patient is understanding in his situation
B. Meeting the needs of the patient before providing education
C. Giving written medication information so the patient can look it over when they feel better
D. Involving family members that are symptom-free who can easily learn about the medications
B. Meeting the needs of the patient before providing education
101. A nurse is assessing a drowsy patient brought to the emergency department by a friend. The patient’s eyes are dilated, and his speech is slurred. The friend reports the patient just wanted to experiment and “party” and took OxyContin. What is the primary source of pain relievers for illicit drug use?
A. Peer
B. Drug dealers
C. Family members
D. Strangers
C. Family members
102. Which prescription drug class that is used illicitly will result in increased admissions to publicly funded substance-abuse treatment programs and more frequent emergency department admissions?
A. Pain relievers
B. Sedatives
C. Tranquilizers
D. Stimulants
A. Pain relievers
103. A 72-year-old male develops a rash after one day of treatment with amoxicillin for acute otitis media. What is the next drug that the nurse should consider to treat this patient’s acute otitis media?
A. Levaquin
B. Omnicef
C. Bactrim
D. Augmentin
B. Omnicef
104. In an interview regarding his individual drug therapy, a 56-year-old man asked if there are any side effects to a particular medication. What is the best response for the APN to give the patient?
A. Yes, but the healthcare team will monitor for any side effects
B. Yes, all medications have side effects
C. Yes, let me talk with you about those side effects
D. Why do you ask?
D. Why do you ask?
105. When a drug is found to be a look alike/sound alike drug, who is ultimately responsible to approve the name change?
A. The federal drug administration
B. The manufacturer
C. The national pharmacy chain
D. National drug distributor
A. The federal drug administration (FDA)
106. A 69-year-old female patient is being discharged from the hospital with instructions to continue her previous medications of aspirin, furosemide, potassium, and lisinopril. She is instructed to add Lanoxin 0.25 mg daily and acetaminophen 500 mg 1 to 2 tablets every 6 to 8 hours as needed for pain. The APN calls the prescribing healthcare provider to verify the dose of acetaminophen. This scenario exemplifies which type of action?
A. Identifying potential and actual drug related problem
B. Resolving actual drug related problem
C. Preventing potential drug related problem
D. Monitoring drug related problem
C. Preventing potential drug related problem
107. What is an example of how medication shortages affect patients?
A. A patient has to purchase generic ibuprofen because Advil is unavailable
B. A patient dies from sepsis since there is no antibiotic sensitive to an identified pathogen
C. A woman has a miscarriage because RhoGAM is unavailable
D. Lisinopril is substituted for Prinivil because Prinivil is unavailable from any manufacture
C. A woman has a miscarriage because RhoGAM is unavailable
108. A nurse is caring for a patient on aspirin, warfarin, metoprolol, and acetaminophen. The nurse understands that the utilization of pharmacogenomics is most helpful in managing which medication therapy?
A. Warfarin
B. Metoprolol
C. Ibuprofen
D. Acetaminophen
A. Warfarin
109. An APN orders a nonformulary medication for a patient. What is a possible problem with ordering nonformulary drugs?
A. medication that is non-FDA approved
B. Receiving substandard medication
C. Delay in receiving medication
D. Increased possibility of counterfeit medication
C. Delay in receiving medication
110. A 55-year-old male diabetic patient is currently taking Actos, among other medications, with good glycemic control. During his office visit, he states that he has a new employer and therefore, new insurance coverage as well. His new insurance company requires prior authorization for this medication. What does the nurse explained to the patient?
A. He is responsible to pay for the Actos out-of-pocket
B. He should be switched from Actos to Actiq since it is less expensive and more efficacious
C. There is no change in medication usage because Medicare part D covers his prescriptions
D. He must wait for approval from his insurance company before filling his prescription
D. He must wait for approval from his insurance company before filling his prescription
114. The parent of an eight-year-old female patient being treated for asthma asked a nurse practitioner why albuterol is covered by her insurance plan when Xopenex has fewer side effects. Her daughter frequently reports tachycardia and tremor following albuterol nebulizer treatment. The nurse practitioner explains that Xopenex is significantly more expensive, and it is frequently not covered. What is the most likely reason that Xopenex is not covered by many insurance companies?
A. Xopenex is a new drug, and many insurance companies are not for familiar with it
B. Outcomes for the two drugs are the same and therefore the increased cost is not justified
C. Insurance companies are concerned with the excessive cost since asthma is very common
D. Xopenex has a higher incidence of allergic reactions, which increases cost of coverage
B. Outcomes for the two drugs are the same and therefore the increased cost is not justified
115. Which scenario best supports the use of pharmacoeconomic evaluation when comparing the following options?
A. And APN is asked by a physician in the same practice to research the quality-of-life measures for two of the most popular drugs prescribed for rheumatoid arthritis. The physician would like to know how drug A compares to drug B from anecdotal evidence of patients who have used H, specifically qualitative measures regarding how much the patient’s quality of life has improved after six months of therapy on each drug.
B. And APN is asked by the physician in the same practice to research the biochemical method by which a certain anti-emetic drug (Drug A) works, compared to another drug (drug B) whose off-label use would be as an anti-nausea medication. The APN is asked to provide a side-by-side comparison of all possible contraindications of each drug
C. And APN is collaborating with hospital administrators to help decide what chemotherapy drug should be on the formulary. Drug A is well tolerated, effective, and expensive. Drug B is also effective, but has more side effects, and is significantly less expensive. The administrators have asked the APN to research data supporting the additional cost of drug A.
D. And APN is asked by a patient for a comparison of birth control pill A with birth control pill B. Specifically, the patient would like to know the side effects of each pill, as well as how often each must be taken, and the efficacy of each at preventing pregnancy.
C. An APN is collaborating with hospital administrators to help decide what chemotherapy drug should be on the formulary. Drug A is well tolerated, effective, and expensive. Drug B is also an effective, but has more side effects, and is significantly less expensive. The administrators have asked the APN to research data supporting the additional cost of Drug A.
116. A three-year-old patient presents with symptoms of a sinus infection, coughing, and wheezing. The patient’s mother states that immune deficiencies run in the family. Which two medications may be helpful for this patient’s condition?
A. Over-the-counter cold medications
B. Antibiotic for sinus infection
C. Albuterol SVN
D. Daily fiber supplements
E. Racemic epi SVN
B. Antibiotic for sinus infection
C. Albuterol SVN
117. A 14-year-old patient is brought to the emergency department unconscious by her friends mother. The patient’s medical records show previous labs indicating beta cell destruction and a previous admission with ketoacidosis. The patient’s blood glucose is 743. Which three drug therapies are appropriate?
A. One amp of D50
B. IV normal saline bolus
C. Lactated ringer’s IV bolus
D. Glucagon
E. Insulin
F. Kayexalate
G. Potassium
B. IV normal saline bolus
E. Insulin
G. Potassium
118. The patient is in the preoperative area for a carpal tunnel release. During the interview, the patient states that he is a past opioid abuser and has a narcotic contract with his primary care physician. What is a treatment option for this patient to avoid the use of intraoperative narcotics?
A. Hypnotism
B. Bier Block and Toradol
C. The first surgery until patient can be screened for drug abuse
D. PO Tylenol
B. Bier Block and Toradol
119. A 44-year-old male patient presents with shortness of breath, diaphoresis, and tachycardia. During the interview, the nurse finds that the patient has smoked a pack of cigarettes per day for 30 years. The nurse notices clubbing on the fingers. The patient states that his last doctor put him on a long-acting bronchodilator, but that he is still short of breath with daily activities. Which intervention with this diagnosis can reduce mortality?
A. Metoprolol
B. Niacin
C. Oxygen therapy
D. Incentive Spirometry
C. Oxygen therapy
120. A 69-year-old patient comes to a clinic with the complaint of increased forgetfulness. In the interview, the nurse notices that the patient has a history of falling and poor recall and has been diagnosed with CHF and Parkinson’s disease. The patient takes several medications daily and is on a fixed income. Which consideration must be made for this patient and the treatment plan?
A. Communication only with the patient is imperative to agree on a plan of care
B. Education, communication, and planning with a designated caregiver are key
C. Institutionalization is the next step to safely manage this patient’s disorder and medications
D. The patient’s medications need to be discontinued because of the patient’s poor memory and increased risk of overdose
B. Education, communication, and planning with a designated caregiver are key
121. A patient with a BMI of 42 has an allergy to insect bites and a history of anaphylactic shock. The nurse prescribes an EpiPen for the patient to carry at all times. Which consideration should be made in this treatment plan?
A. If the patient has a fast heart rate and trembling after an injection, the patient should consider epinephrine as an allergy
B. Two doses of the EpiPen should be used
C. The patient should never self-administer the EpiPen
D. The EpiPen should be used even if it’s expired
B. Two doses of the EpiPen should be used
123. The patient is remitted to the ICU with chronic heart failure her. The patient has elevated natriuretic peptides and is short of breath at rest. The patient’s lungs have crackles bilaterally, and there is 4+ pitting Adema in all extremities. Patient takes and ACEi, loop diuretic, digoxin, and nitrates routinely. What are other treatment options for this patient?
A. Chronic inotropes and heart transplant
B. IV potassium and calcium channel blocker
C. Hemodialysis
D. Physical therapy
A. Chronic inotropes and heart transplant
124. The nurse is reviewing discharge papers for a patient who is hospitalized because of a life-threatening adverse drug event. The nurse understands that this is a qualifying event for the MedWatch, the FDA adverse drug report monitoring system. Which additional information does the nurse also understand?
A. The prescriber does not have to report the adverse event to MedWatch since no permanent damage or death resulted
B. No specific member of the healthcare team is responsible to report, as participation in MedWatch is voluntary
C. The prescriber is legally responsible to report adverse event to MedWatch
D. Any licensed practitioner who cares for the patient is legally responsible to verify that the event was reported to MedWatch
B. No specific member of the healthcare team is responsible to report, as participation in MedWatch is voluntary
125. Which action should a nurse take as a provider and a large oncology infusion unit when made aware that there is a shortage of the drug Doxil that is currently received from Janssen products?
A. Alert the FDA so legal action can be taken against Janssen
B. Alert the FDA and begin to dilute the concentration of Doxil on hand so the supply will last longer
C. Report the shortage to the FDA so underlying cause for shortage can be addressed
D. Alert the FDA so production of the drug can be increased
C. Report the shortage to the FDA so the underlying cause of shortage can be addressed
126. Which type of communication is imperative to decrease drug shortage-related issues?
A. Communication between patients and providers
B. Communication between the FDA and the White House
C. Communication between the public and the FDA
D. Communication between the Surgeon General and the FDA
C. Communication between the public and the FDA
127. What is the role of the center for drug evaluation and research (CDER)?
A. To inform patients about purchasing their own supply of drugs in short supply
B. To address drug shortages that have a significant impact on public health
C. To oversee manufacturing and shortage of drugs made in the United States
D. To oversee pricing of drugs being manufactured and sold in the United States
B. To address drug shortages that have a significant impact on public health
128. A new drug’s adverse effects are often not seen until it is administered to a large number of individuals outside of well-regulated guidelines. In which phase of drug development does this occur?
A. Phase I
B. Phase II
C. Phase III
D. Phase IV
E. Phase V
D. Phase IV
129. What is the best resource for providers to obtain up-to-date information on drug shortages?
A. Federal drug administration
B. Mainstream media sources
C. Physicians desk reference
D. Center for disease control
A. Federal drug administration
130. A nurse is caring for a patient who requires an overdose of MS04 requiring administration of Narcan. Which medication error index would this be considered?
A. Category A
B. Category B
C. Category C
D. Category D
E. Category E
E. Category E
131. Many states have passed or are considering legislation to allow access to marijuana for medical use. Which trend does this exemplify?
A. Termination of the war on illicit drugs
B. escalation of the war on the illicit drugs
C. Maintenance of the war on illicit drugs
D. De-escalation of the war on illicit drugs
D. De-escalation of the war on illicit drugs
132. And advanced practice nurse is reviewing the patient information in the state prescription database. The nurse would expect to find records related to which information?
A. All prescription medications
B. All controlled substance prescriptions
C. All narcotic prescription medications
D. All scheduled C-II and scheduled C-III prescriptions
B. All controlled substance prescriptions
133. Which measure has the federal government taking an effort to reduce prescription drug abuse?
A. Defers the decision for monitoring controlled substances to pharmacists
B. Defers the decision for monitoring controlled substances to individual prescribers
C. Defers the decision for monitoring controlled substances to each state
D. Requires each state to have a controlled substance monitoring program
C. Defers the decision for monitoring control substances to each state
134. An APN understands that prescriptive authority and practice are regulated by which entity?
A. The state through the board of medicine
B. The state through legislative authority
C. The federal government
D. The state through the board of nursing
B. The state through legislative authority
135. Which objective is the American Academy of nurse practitioners seeking to achieve by encouraging all states to provide unrestricted prescriptive authority to nurse practitioners?
A. To acknowledge the advanced training and education of nurse practitioners
B. To allow nurse practitioners to practice in a variety of settings
C. To provide comprehensive healthcare services
D. To encourage equality with physician counterparts
C. To provide comprehensive healthcare services
136. A 15-year-old male patient comes to a clinic for sports physical. He has an odor, dilated blood vessels in the eyes, and is tachycardic. The nurse suspects marijuana use. What is the nurses role as a care provider in this situation?
A. Inquire to the parents of the patient about possible source of marijuana
B. Discourage the patient from participating in sports until he is a nonuser
C. Recommend inpatient treatment to prevent further substance abuse
D. Know the youth prevention-related measures to decrease the risk of escalation of abuse
D. Know the youth prevention-related measures to decrease the risk of escalation of abuse
137. A nurse is doing clinical rotations in a family health clinic that has a large population of adolescent patients. What is the nurses role as a healthcare provider in regards to substance-abuse when performing assessments on adolescents?
A. The nurse should tell the patient that you will detect any drugs in the system at the next physical to prevent them from experimenting with drugs
B. The nurse should not approach the subject of substance abuse unless the patient has physical signs of abuse
C. The nurse should try to elicit information from all school aged patients regardless of the patient’s age or appearance
D. The nurse should instruct the school guidance counselor to address the topic as it is not the role of the provider to discuss substance abuse
C. The nurse should try to elicit information from all school aged patients regardless of the patient’s age or appearance
138. A 50-year-old male patient complains of frequent heartburn after dinner and he states that he “eats Tums all night long” most nights. The antacid does not appear to be effective as his heartburn continues to interfere with his sleep. He has began to take Benadryl each night to help him sleep better. What is the potential adverse effects of these two drugs being taken together that could explain the patient’s condition?
A. The combination of the drugs can have a drug effects opposite of the desired effect, creating worst heartburn
B. The Tums speed up the rate of digestion preventing the body from absorbing the Benadryl
C. The Tums increased the pH in the stomach, which decreases the ionization of-based drugs, resulting in a decrease drug effect
D. The Tums lower the pH in the stomach and increase ionization of base drugs, resulting in a decreased drug effect
C. The Tums increase of the pH in the stomach, which decreases ionization of base drugs, resulting in a decrease drug effect
139. The client informs the nurse that he uses herbal compounds given by a family member to treat his hypertension. What is the most appropriate action by the nurse?
A. Inform the client that the herbal treatments will be ineffective
B. Obtain more information and determine whether herbs are compatible with medications prescribed
C. Notify the healthcare provider immediately
D. Inform the client that the healthcare provider will not treat him if he does not accept the use of traditional medicine only
B. Obtain more information and determine whether the herbs are compatible with the medications prescribed
141. The nurse understands the gender issues also influence pharmacotherapy. What are some important considerations for the nurse to remember about these differences?
A. Man seek healthcare earlier than women
B. Women may not seek treatment for cardiac conditions as quickly as men
C. Women are more likely to stop taking medications because of side effects
D. All drug trials are conducted on male subjects
B. Women may not seek treatment for cardiac conditions as quickly as men
142. The client informs the nurse that she will decide whether she will except treatment after she prays with her family and minister. What is the role of spirituality and drug therapy for this client?
A. Irrelevant because medications at on scientific principles
B. Important to the client acceptance of medical treatment and response to treatment
C. Harmless if it makes the client feel better
D. Harmful, especially if treatment is delayed
B. Important to the clients acceptance of medical treatment and response to treatment
143. Clients characterized as slow acetylators may experience what effects related to drug therapy?
A. They are more prone to drug toxicity
B. They may require more time to absorb you enteral medications
C. They must be given liquid medications only
D. They should be advised to decrease protein intake
A. They are more prone to drug toxicity
145. The nurse obtained information during the admission interview that the client is taking herbal supplements in addition to prescribe medications. What is the nurses primary concern for this client?
A. Herbal products are natural and poses no risk to the client but may be costly
B. Herbal products are welcome supplements to conventional medications but do not always come with instructions
C. The client may be at risk for allergic reactions
D. The herbal products may interact with prescribed medications and affect drug action
D. The herbal products may interact with prescribed medications and affect drug action
146. The client states that he has been using the herbal product Saw Palmetto. The nurse recognizes that this supplement is often used to treat which condition?
A. Insomnia
B. Urinary problems associated with prostate enlargement
C. Symptoms of menopause
D. Urinary tract infection
B. Urinary problems associated with prostate enlargement
148. The client has been given a prescription of furosemide (Lasix) as an adjunct to treatment of hypertension and returns for a follow-up check. Which of the following is the most objective data for determining the therapeutic effectiveness of the furosemide?
A. Absence of edema in the lower extremities
B. Weight loss of 6 pounds
C. Blood pressure log notes blood pressure 120 over 70 mmHg to 134/80 8 mmHg since discharge
D. Frequency avoiding of at least six times per day
C. Blood pressure log notes blood pressure 120/70 mmHg to 134/88 mmHg since discharge
149. Nifedipine (Procardia) has been ordered for a client with hypertension. In the care plan, the nurse includes the need to monitor for which adverse effect?
A. Rash and chills
B. Reflex tachycardia
C. Increased urinary output
D. Weight loss
B. Reflex tachycardia
150. The client is taking atenolol (Tenorman) and doxazosyn (Cardura). what is the rationale for combining two antihypertensive drugs?
A. The blood pressure will decrease faster
B. Lower doses of those drugs may be given with fewer adverse effects
C. There is less daily medication dosing
D. Combination therapy will treat the patients other medical conditions
B. Lower doses of both drugs may be given with fewer adverse effects
151. What health teaching should the nurse provide for the client receiving nadolol (Corgard)?
A. Increase fluids and fiber to prevent constipation
B. Report a weight gain of 1 kg per month or more
C. Immediately stopped taking the medication if sexual dysfunction occurs
D. Rise slowly after prolonged periods of sitting or lying down
D. Rise slowly after prolonged periods of sitting or lying down
152. The nurse is preparing to administer the first dose of enalapril (Vasotec). Identify the potential adverse effects of this medication (select all that apply).
A. Reflex hypertension
B. Hyperkalemia
C. Persistent cough
D. Angioedema
E. Hypotension
B. Hyperkalemia
C. Persistent cough
D. Angioedema
E. Hypotension
153. A client with significant hypertension and responsive to other medications is given a prescription for hydralazine (Apresoline). And additional prescription for Propanolol (Inderal) is also given to the client. The client inquiries why to drugs are needed. The best response is?
A. Giving the two drugs together will lower the blood pressure even more than just with one alone
B. The hydralazine may cause tachycardia and the propanolol will help keep the heart rate within normal limits.
C. The propanolol is to prevent lupus erythematosus from developing
D. Direct-acting vasodilators such as hydralazine cause fluid retention and the propanolol will prevent excessive fluid buildup
B. The hydralazine may cause tachycardia and the propanolol will help keep the heart rate within normal limits
154. The client is being discharged with nitroglycerin (Nitrostat) for sub lingual use. While planning client education, what instruction will the nurse include?
A. Swallow three tablets immediately for pain and call 911
B. Put one tablet under your tongue for chest pain. If pain does not subside, you May repeat in five minutes, taking no more than three tablets
C. Call your healthcare provider when you have chest pain. He will tell you how many tablets to take
D. Place three tablets under your tongue and call 911
B. Put one tablet under your tongue for chest pain. If pain does not subside, you may repeat in five minutes, taking no more than three tablets.
155. Nitroglycerin patches have been ordered for a client with a history of angina. What teaching will the nurse give to this client?
A. Keep the patches in the refrigerator
B. Use the patches only if the chest pain is severe
C. Remove the old patch before applying a new one
D. Apply the patch only to the upper arm or thigh areas
C. Remove the old patch before applying a new one
156. Which of the following assessment findings in a client who is receiving atenolol (Tenormin) for angina would be cause for the nurse to hold the drug and contact the provider? (Select all that apply)
A. Heart rate of 50 bpm
B. Heart rate of 124 bpm
C. Blood pressure 86/56
D. Blood pressure 156/88
E. Tinnitus and vertigo
A. Heart rate 50 bpm
C. Blood pressure 86/56
157. The nurse is caring for a client with chronic stable angina who is receiving isosorbide dinitrate (Isordil). Which of the following are common adverse effects of isosorbide?
A. Flushing and headache
B. Tremors and anxiety
C. Sleepiness and lethargy
D. Light-headedness and dizziness
D. Light-headedness and dizziness
158. Erectile dysfunction drugs such as sildenafil (Viagra) are contraindicated in clients taking nitrates for angina. What is the primary concern with concurrent administration of these drugs?
A. They contain nitrates, resulting in an overdose
B. They decreased blood pressure and may result in prolonged and severe hypotension when combined with nitrates
C. They will adequately treat the patients angina as well as erectile dysfunction
D. They will increase the possibility of nitrate tolerance developing and should be avoided unless other drugs can be used
B. They decreased blood pressure and may result in prolonged and severe hypotension when combined with nitrates
159. A client with asthma has a prescription for two inhalers, albuterol (Proventil, VoSpire) and beclomethasone (Qvar). How should the nurse instruct this client on the proper use of the inhalers?
A. Use the albuterol inhaler, and used a beclomethasone only if symptoms are not relieved
B. Use the beclomethasone inhaler, and use the albuterol only if symptoms are not relieved
C. Use the albuterol inhaler, wait 5-10 minutes, then use the beclomethasone inhaler
D. Use the beclomethasone inhaler, wait 5-10 minutes, then use the albuterol inhaler
C. Use the albuterol inhaler or, wait 5-10 minutes, then use the beclomethasone inhaler
160. The client has been using a fluticasone (Flovent) inhaler as a component of his asthma therapy. He returns to his healthcare providers office complaining of a sore mouth. On inspection, the nurse notices white patches in the clients mouth. What is a possible explanation for these findings?
A. The client has been consuming hot beverages after the use of his inhaler
B. The client has limited his fluid intake, resulting in dry mouth
C. The residue of the inhaler propellant is coating the inside of his mouth
D. The client has developed thrush as a result of the fluticasone
D. The client has developed thrush as a result of the fluticasone
162. Which of the following represents an appropriate outcome established during the planning phase?
A. The nurse will teach the patient to recognize and respond to adverse effects from the medication
B. The patient will demonstrate self administration of the medication, using a preloaded syringe into the subcutaneous tissue of the thigh, prior to discharge
C. The nurse will teach the patient to accurately prepare a dose of medication
D. The patient will be able to self manage his disease and medications
B. The patient will demonstrate self administration of the medication, using a preloaded a syringe into the subcutaneous tissue of the thigh, prior to discharge
164. Which factor is most important for the nurse to assess when evaluating the effectiveness of the patients drug therapy?
A. The patients promise to comply with the drug therapy
B. The patient satisfaction with the drug
C. The cost of the medication
D. Evidence of therapeutic benefit from the medication
D. Evidence of therapeutic benefit from the medication
167. A client is receiving hydralazine (Apresoline) for elevated blood pressure levels. The nurse would include into the care plan to monitor the client for which adverse effects?
A. Atelectasis
B. Crystalluria
C. Photosensitivity
D. Orthostatic hypotension
D. Orthostatic hypotension
168. A client with hypertensive crisis is started on nitroprusside (Nipride) therapy. The nurse would perform what priority intervention during the course of this treatment?
A. Monitor for the presence or absence of bowel sounds
B. Obtain urine samples for specific gravity measurements and glucose levels
C. Observe skin pressure points for turgor and integrity
D. Titrate intravenous infusion rate according to the blood-pressure response
D. Titrate intravenous infusion rate according to the blood-pressure response
161. A 65-year-old client is prescribed ipratropium (Atrovent) for the treatment of his asthma. Which of the following conditions should be reported to the health care provider before giving this client the ipratropium?
A. They reported allergy to peanuts
B. A history of intolerance to albuterol (Proventil, VoSpire)
C. A history of bronchospasms
D. I reported allergy to chocolate
A. They reported allergy to peanuts
163. A 15-year-old adolescent with a history of diabetes is treated in the emergency department for complications related to skipping her medications for diabetes. She says she skipped medications because she did not want to gain weight and is afraid of needle marks. Before establishing a diagnosis of “noncompliance,” what should the nurse assess?
A. Whether the patient received adequate teaching related to her medication and expresses an understanding of the teaching
B. Whether the patient was encouraged to skip her medication by a family member or friend
C. Whether the patient is old enough to understand the consequences of her actions
D. Whether the provider will write another prescription because the patient refused to take medication the first time
A. Whether the patient received adequate teaching related to her medication and expresses an understanding of the teaching
165. Which method may offer the best opportunity for patient teaching?
A. Providing detailed written information when the client is discharged
B. Providing the patient with Internet links to conduct research on drugs
C. Referring the patient to external health care groups they provided patient education, such as the American Heart Association
D. Providing education about the patient’s medication each time the nurse administers the drugs
D. Providing education about the patient’s medications each time the nurse administers the drugs
166. Methyldopa (Aldomet) is being initiated for a client with hypertension. Which health teaching would be most appropriate for this drug?
A. Avoid hot baths and showers, and prolonged standing in one position
B. This drug make this color the urine a pinkish-brown color
C. You may experience bloating and Weight gain
D. The tablet be should taken only with food or milk
A. Avoid hot baths and showers, and prolong standing in one position
 

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Reflection on the Shadow Health Virtual Assignments: Enhancing Clinical Skills and Critical Thinking

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Shadow Health Reflection: Musculoskeletal And Neurological

  • Complete the ShadowHealth© Musculoskeletal and Neurological assignments

Professional Development

  • Write a 500-word APA reflection essay of your experience with the Shadow Health virtual assignment(s). At least two scholarly sources in addition to your textbook should be utilized. Answers to the following questions may be included in your reflective essay:
    • What went well in your assessment?
    • What did not go so well? What will you change for your next assessment?
    • What findings did you uncover?
    • What questions yielded the most information? Why do you think these were effective?
    • What diagnostic tests would you order based on your findings?
    • What differential diagnoses are you currently considering?
    • What patient teaching were you able to complete? What additional patient teaching is needed?
    • Would you prescribe any medications at this point? Why or why not? If so, what?
    • How did your assessment demonstrate sound critical thinking and clinical decision making?

 

Introduction (approximately 150 words)

Virtual simulations have become an integral part of healthcare education, offering students a unique opportunity to apply their knowledge and skills in a realistic clinical setting. In this reflective essay, I will share my experience with the Shadow Health virtual assignments and discuss the outcomes of my assessment. By critically examining what went well and what could be improved, I aim to enhance my clinical thinking and decision-making abilities.

Assessment Successes and Challenges (approximately 300 words)

During the virtual assignments, several aspects of my assessment went well. The simulated patient interactions provided a safe environment to practice communication skills, history-taking, and physical examination techniques. The feedback received from the virtual patient and faculty was valuable in improving my clinical approach. Moreover, the integration of multimedia elements, such as visual representations and interactive activities, enhanced my learning experience.

However, I encountered some challenges as well. Time management proved to be a significant hurdle, as I struggled to gather all the necessary information within the allotted timeframe. This hindered my ability to conduct a comprehensive assessment and formulate an accurate diagnosis. Additionally, I realized that I needed to improve my proficiency in utilizing the software’s features effectively to maximize the learning potential.

Findings and Effective Questioning (approximately 300 words)

Throughout the virtual assignments, I uncovered various findings that assisted in the patient’s evaluation. For instance, by systematically asking about the patient’s symptoms and medical history, I was able to identify relevant details regarding their condition. Additionally, physical examination techniques, such as auscultation and palpation, provided valuable information about the patient’s overall health.

Certain questions yielded the most information during the assessments. Open-ended questions allowed the patient to share their experiences, emotions, and concerns, enabling a more comprehensive understanding of their condition. These questions were effective because they promoted patient-centered care, encouraged active listening, and fostered a trusting therapeutic relationship.

Diagnostic Tests and Differential Diagnoses (approximately 300 words)

Based on the findings from the assessments, several diagnostic tests would be appropriate to confirm or rule out potential conditions. For instance, laboratory tests such as complete blood count (CBC), comprehensive metabolic panel (CMP), and urinalysis could provide insights into the patient’s physiological status. Additionally, imaging studies like X-rays or ultrasounds might be warranted to visualize specific organs or structures.

Considering the patient’s symptoms and findings, several differential diagnoses come to mind. These include but are not limited to pneumonia, gastroesophageal reflux disease (GERD), anxiety disorder, and chronic obstructive pulmonary disease (COPD). A thorough review of the patient’s history, physical examination findings, and diagnostic test results would help narrow down the possibilities and establish a more accurate diagnosis.

Patient Teaching and Medication Prescriptions (approximately 300 words)

During the assessments, I was able to provide the patient with some educational materials and instructions related to their condition. For instance, I discussed lifestyle modifications, such as smoking cessation and dietary changes, to promote optimal health. However, additional patient teaching is needed regarding the importance of adherence to prescribed medications, potential side effects, and strategies to manage symptoms effectively.

At this point, prescribing medications would not be appropriate without further evaluation and confirmation of the diagnosis. A comprehensive assessment, including additional diagnostic tests and collaboration with healthcare professionals, is necessary before considering any medication prescriptions. Ensuring patient safety and evidence-based practice should guide the decision-making process.

Critical Thinking and Clinical Decision Making (approximately 300 words)

The virtual assignments demonstrated my ability to apply sound critical thinking and clinical decision-making skills. By analyzing the patient’s history, physical findings, and diagnostic data, I was able to identify patterns, make connections, and generate appropriate differential diagnoses. I critically evaluated the patient’s symptoms

 

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Select a health care organization in your community to conduct an interview with an appropriate risk management employee. The organization can be your current employer, or a different health care facility in your community. Acute care, urgent care, large multi-provider private medical clinics, assisted living facilities, and community/public health clinical facilities are all ideal options to complete the requirements of this assignment. Make sure to select an individual who can provide sufficient information regarding how that organization manages risk within its facility to answer the questions below.

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Select a health care organization in your community to conduct an interview with an appropriate risk management employee. The organization can be your current employer, or a different health care facility in your community. Acute care, urgent care, large multi-provider private medical clinics, assisted living facilities, and community/public health clinical facilities are all ideal options to complete the requirements of this assignment. Make sure to select an individual who can provide sufficient information regarding how that organization manages risk within its facility to answer the questions below.

In your interview, address the following:

  1. Identification of the challenges the organization faces in controlling infectious diseases.
  2. Risk management strategies used in the organization’s infection control program, along with specific examples.
  3. How the facility’s educational risk management program addresses key professional issues, such as prevention of negligence, malpractice litigation, and vicarious liability.
  4. Policies the facility has implemented that address managing emergency triage in high-risk areas of health care service delivery.
  5. Strategies the facility utilizes to monitor and maintain its risk management program.

Post-interview, compose a 750-1,000 word summary analysis of the interview to include the questions above as well as the following elements:

  1. A brief assessment of the organization’s risk management program, including what works well and what could work better (the pros and cons).
  2. Action steps you would take to improve the program. Select one area and provide your rationale and possible steps required to implement your suggestion.

Answer

Risk management is a top priority in our organization.  The organization I work for is community based and risk management is critical to enhance patient safety and ensure the organization attains its strategic goals. Although risk management is a collective effort by all employees in the organization, risk management is headed by manager of quality assurance, who oversees the operations aimed at preventing occurrence of adverse events that could be injurious to the safety of both employees and the staff.  This paper explores   how risk management is undertaken in the organization. To deduce relevant information concerning risk management, the head of quality assurance, the employee in charge of risk management    in the organization was interviewed and the responses noted.

The first question sought to identify the challenges that the organization faces in controlling infectious diseases.  In response, the head of quality assurance admitted that controlling infections in the organization was indeed a challenge. The main challenge was that the organization mainly handles elderly patients. Empirical research evidence indicates that elderly patients are prone to infectious because of various factors. These include low immunity which increases susceptibility to infections. Secondly, prescription of a wide variety of drugs and poly pharmacy destabilizes the internal microbial environment, thereby increasing susceptibility to infections (Hollnagel, Braithwaite & Wears, 2014).  Additionally,   the effect of antibiotic resistance, which results from unregulated and indiscriminate intake of drugs becomes particularly more evident in old age (Spath & Kelly, 2017). This undermines the efficacy of the existing drugs applied to treat the infections, making it challenging to control the diseases in the community based setting.

The second question inquired about the existing risk management strategies applied in the organization’s infection control program.   The head of quality assurance identified several strategies, including hand washing, promoting environmental hygiene and frequent surveillance. Hand washing strategies applied in the organization complies with the recommended hand washing guidelines and procedures. This includes hand rubbing using soap and running water, rinsing the hands and then drying the hands properly using a single use towel.   In the organization, hand washing is a standard procedure used by the healthcare professionals before and after making direct contact with the patients; after removal of hand gloves and prior to handling invasive equipment or devices. Additionally, it is a standard procedure for the healthcare professionals to wash their hands after handling patient’s secretions, including saliva, blood and other body fluids. Promoting environmental hygiene and safety as a strategy of controlling infections entails thorough cleaning and drying of the surfaces using detergents. Additionally, the organization ensures proper cleaning and handling of used linen, proper disposal of waste and ensuring the facility is well ventilated (Balbir &  Ghatala, 2012).

The third question inquired the extent at which the organization’s education risk management program   addresses key professional issues, such as negligence, malpractice litigation and vicarious liability. In the healthcare facility, educational risk management program address the professional issues in various ways. These includes sensitizing the  employees on the importance of  observing  the professional code of conduct and frequent training and retraining of the  healthcare professionals on  the various  standard operation procedures to prevent medical errors  and other adverse events that could undermine patient safety.  In regards to malpractice litigation, the head of quality assurance revealed that the organization is yet to face malpractice litigation during his tenure. However, the organizations educational risk management program outlines the standard procedure and actions that a healthcare professionals face when confronted with malpractice charges. This includes suspension from work   pending determination of the litigation and in some cases dismissal from the organization.

The policies that the organization has implemented in managing emergency triage in high risk areas of healthcare delivery include Emergency Medical Treatment and Active Labor Act (EMTALA) and Health Insurance Portability and Accountability Act (HIPAA). In regards to the EMTALA policy, the organization is under obligation to deliver healthcare services to all patients and does not engage in patient dumping. However, compliance with the EMTALA depends on various conditions, including the setting in which the patient is situated and confirmation of the availability or lack of the emergency clinical condition as outlines in the EMTALA.

The main strategy that the organization uses to monitor and maintain its risk management program includes frequent review of the program by external agencies. In this case, the organization frequently reviews its program against   the established standards set by regulatory bodies involved in monitoring patient safety in healthcare facilities across the country.  Secondly, the organization frequently uses the recommended international standard safety guidelines to benchmark against its existing risk management program. Additionally, the organization uses the established professional code of ethics in monitoring and maintenance of the risk management program.

From the interview, it is evident that the organization has implemented pragmatic measures in its risk management program to address various hazards, particularly infections.  One of the strengths of the risk management program is the implementation of policies that complies with the established regulations of promoting patient safety in the country.  This includes guidelines of preventing infections and providing healthcare services in emergency settings. However, the main shortcoming of the program is that its education risk program does not involve key stakeholders, including patient and their families.

References

Balbir , S., &  Ghatala , H.(2012).  Risk management in hospitals. International Journal of   Innovation, Management and Technology, 3(4): 417- 421.

Hollnagel, E., Braithwaite, J, & Wears, R. (2014). Resilient health care. Surrey, England: Ashgate.

Spath, P., &  Kelly, D.(2017). Applying Quality Management in Healthcare: A Systems    Approach, 4th Edition. AUPHA/HAP.

 

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Leadership Manager Leader Visionary

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4-5-page paper not counting the Title page and Reference page

A. Introduction:

BRIEFLY Tell me why it is important to understand What a Leader Is, The Leader as a Visionary, The Leader as a Problem Solver and a Leader as a Team Builder. Point out the main points of the paper in the introduction.

B. Body of your paper: (4-5 Pages total in length)

Each of these four sections should be about one page in length:

The student will discuss each of the following sections in a minimum of one page per section:

1. What is a leader? What is a manager? Discuss what were the most interesting parts that you will be able to apply to a work environment? Why?

2. Describe what does it mean when we talk about the “Leader as a Visionary”?

3. Describe what does it mean when we talk about the “Leader as a Problem-Solver”?

4. Describe what does it mean when we talk about the “Leader as a Team-Builder”?

C. Conclusion:

BRIEFLY summarize the contents of the paper. Restate the main points of the paper in the conclusion.

Paper References

Please support your ideas, arguments, and opinions with independent research, include at least three (3) supporting references or sources (do NOT use Wikipedia, unknown, undated, or anonymous sources, such as websites).

Submission Instructions/Check List:

• APA Template used

• Title Page correct

• Abstract not required

• Introduction included

• Body of the paper addresses the 4 sections outlined above

• Headings are used to organize the body of the paper– Review Announcement on Headings

• In Text Citations are correct

• Conclusion included

• All Text is double spaced

• Reference page correct and required three sources are listed

• Paper is 4 – 5 pages in length not counting the title and reference pages.

• Paper is in MS Word and submitted as an attachment in either a .doc or .docx format.

 

Other related articles:

Describe the anticipated barriers to the change process in your institution (or where the change will be implemented). Include the organization’s culture, anticipated reaction to change, and your leadership role for change. 

 

 

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Business Requirements Background Scope

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This assignment consists of two (2) sections: a business requirements document and a project plan. You must submit both sections as separate files for the completion of this assignment. Label each file name according to the section of the assignment it is written for. Additionally, you may create and / or assume all necessary assumptions needed for the completion of this assignment.

Procuring quality business requirements is an important step toward the design of quality information systems. Completion of a quality requirements document allows user needs and expectations to be captured, so that infrastructure and information systems can be designed properly. Your company, which is a data-collection and analysis company that has been operating less than two (2) years, is seeking to create a repository for collected data beyond standard relational databases. Your ten (10) terabyte data warehouse is expected to grow by 20% each year. You are mindful of data warehousing best practices which will aid you immensely in your requirements gathering effort. Using the requirements document provided in the course shell, you are to speculate on the needs of the company. You must consider current and future requirements; however, assumptions should be realistic and carefully considered.

Section 1: Business Requirements Document

  1. Write a four to six (4-6) page original business requirements document for the project plan using the template provided. Note: The template is provided under the Additional Resources in the Student Center tab of the online course shell.
    • Describe the project including the following:
      • Describe and define the scope of the project.
      • Speculate as to how to control the scope.
      • Identify possible risks, constraints, and assumptions.
      • Describe the relationship and integration between systems and infrastructure. Note: Database and Data Warehousing, Analytics, Interfaces and Cloud Technology, and Infrastructure and Security should be considered.
      • Speculate upon potential outsourcing or offshoring needs.
      • Identify and justify the necessary resources including staffing that are necessary.
      • Define relevant terms that will be used throughout project.
    • Use at least two (2) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources.

Your assignment must follow these formatting requirements:

  • Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
  • Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

Section 2: Revised Project Plan

Use Microsoft Project to:

  1. Update the project plan from Project Deliverable 1: Project Plan Inception, with three to five (3-5) new project tasks each consisting of five to ten (5-10) sub-tasks.

The specific course learning outcomes associated with this assignment are:

  • Evaluate an organization through the lens of non-IT senior management in deciding how information systems enable core and supportive business processes as well as those that interface with suppliers and customers.
  • Use technology and information resources to research issues in information systems.
  • Write clearly and concisely about strategic issues and practices in the information systems domain using proper writing mechanics and technical style conventions.
 

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January-12-2019

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1250 words (not including in-text citation and references as the word count) count a minimum of three scholarly sources are required in APA format. For the three scholarly sources it should be one from the textbook attached and two outside sources. Let’s be sure to write it in own work 100% and give appropriately when using someone’s else work.

INSTRUCTIONS: Using AT LEAST 300 words per response (not including your reference list), respond to the following questions using the reading material attached and Scholarly sources as references.

1. Discuss the three forms of innovation as they are categorized in terms of the degree to which they demand changes in behavior from adopters. Provide an example of products that fit each of the three forms of innovations. Discuss the significance of these innovations. How does the promotion for these products differ?

2. What is creolization and what does it have to do with the adoption of marketing strategies? If you were in charge of international markets for Kraft Foods, would you focus primarily on the etic or emic perspectives? Would your answer change if you worked for Ford? Explain.

3. Discuss geodemography and the use of geodemographic marketing techniques in the marketing of products or services. What assumptions are made and how accurate are these assumptions? Provide an example of where you have seen geodemographic marketing used effectively.

4. Discuss the five types of social powers and for each provide an example of a time when, as a consumer, you were influenced by an individual with this power.

 

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discussion 5 gowtham

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(RS) Discussion Question 5: Incident Response Strategies

Discussion Requirements

You are provided a handout that describes a scenario in which an incident occurred along with corrective actions taken. The handout also includes a description of the phases of information security incident response.

Tasks

Discuss the phases of a typical information security incident response. Using the information presented in the handout, discuss the following questions:

  • What are the effective responses to a security breach?
  • Which actions you would recommend for each phase?

Summarize your thoughts in a Microsoft Word document checking for spelling and grammar, then submit it directly (cut & paste) into the discussion thread. Respond to at least two other students’ views to engage in a meaningful debate regarding their posts or to defend your post.

Required Resources

Submission Requirements

  • Format: Please enter directly into the Discussion Question window
  • Citation Style: Follow APA
  • At least 300 words
  • Spelling and Grammar count so I suggest you first type your post into MS Word and check for spelling and grammar. You can then cut & Paste into the Discussion Question thread.

Self-Assessment Checklist

  • I identified effective responses to a security breach.
  • I recommended at least one action for each phase.
  • I responded to at least two other students’ views to engage in a meaningful debate regarding their choices or to defend my choices.
 

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Employment discrimination paper

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write two page paper on employment discrimination.

 

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