Assessing Client Family Progress

  Practicum – Assessing Client Family Progress

Learning Objectives

Students will:

· Create progress notes

· Create privileged notes

· Justify the inclusion or exclusion of information in progress and privileged notes (SEE ATTACHED SAMPLE OF PROGRESS AND PRIVILIGED NOTE)

· Evaluate preceptor notes

To prepare:

· Reflect on the client family you selected for the Week 3 Practicum Assignment (SEE ATTACHED WEEK 3 NOTE),

                                                             The Assignment

                 Part 1: Progress Note

Using the client family from your Week 3 Practicum Assignment address in a progress note (without violating HIPAA regulations) the following:

· Treatment modality used and efficacy of approach

· Progress and/or lack of progress toward the mutually agreed-upon client goals

(reference the treatment plan for progress toward goals)

· Modification(s) of the treatment plan that were made based on progress/lack of

progress

· Clinical impressions regarding diagnosis and or symptoms

· Relevant psychosocial information or changes from original assessment (e.g.,

marriage, separation/divorce, new relationships, move to a new

house/apartment, change of job)

· Safety issues

· Clinical emergencies/actions taken

· Medications used by the patient, even if the nurse psychotherapist was not the

one prescribing them

· Treatment compliance/lack of compliance

· Clinical consultations

· Collaboration with other professionals (e.g., phone consultations with physicians,

psychiatrists, marriage/family therapists)

· The therapist’s recommendations, including whether the client agreed to the

recommendations

· Referrals made/reasons for making referrals

· Termination/issues that are relevant to the termination process (e.g., client

informed of loss of insurance or refusal of insurance company to pay for

continued sessions)

· Issues related to consent and/or informed consent for treatment

· Information concerning child abuse and/or elder or dependent adult abuse,

including documentation as to where the abuse was reported

· Information reflecting the therapist’s exercise of clinical judgment

Note: Be sure to exclude any information that should not be found in a discoverable progress note.

                       Part 2: Privileged Note

· Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client family from the Week 3 Practicum Assignment. (SEE ATTACHED WEEK 3 NOTE),

In your progress note, address the following:

· Include items that you would not typically include in a note as part of the clinical record.

· Explain why the items you included in the privileged note would not be included in the client family’s progress note.

· Explain whether your preceptor uses privileged notes. If so, describe the type of information he or she might include. If not, explain why.

Statistics for Nursing Research:

Complete Exercises 6, 8, and 9 in Statistics for Nursing Research: A Workbook for Evidence-Based Practice, and submit as directed by the instructor.

 

 

 

 

 

Use MS Word to complete “Questions to be Graded: Exercise 27” in Statistics for Nursing Research: A Workbook for Evidence-Based Practice. Submit your work in SPSS by copying the output and pasting into the Word document. In addition to the SPSS output, please include explanations of the results where appropriate.

NURS 3375 Health Policy And Legal Aspect (Assignment)

Overview: Peer Review

In the Module 3 Reflection Assignment, you will reflect upon what you have learned about Peer Review Committee processes and Texas Board of Nursing rules as you consider the actions of fictitious nurses and committee members in scenarios. REMEMBER, YOU ARE USING THE TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. Please use the link provided in the assignment for the Texas BON Rule 217.16.

ALSO, THERE ARE 2 PARTS TO THIS ASSIGNMENT. PLEASE MAKE SURE YOU COMPLETE BOTH PARTS.

Refer to your course readings and lectures as you complete the assignment.

Performance Objectives:

· Apply the Minor Incident Rule to specific incidents.

· Describe the due process protections for a nurse who is peer-reviewed.

Rubric

Use this rubric to guide your work on the assignment, “Peer Review.”

 

Task

Accomplished

Proficient

Needs Improvement

 

Part 1 (a)

Applying Rule 217.16

(Total 50 points)

Lists all the correct 5 criteria, accurately explains application of   criteria clearly. (25 points)

Lists 3 or 4 of the   correct criteria, accurately explains application of these criteria

(15 points)

Lists 2 applications of criteria.

10 points)

Incorrectly lists criteria (0   point)

 

Part   1 (b)

Reflects upon applications

of Rule 217.16

(Total 25 points)

Correctly states if nurse should be reported or not reported with 3 substantial sentences. (25 points)

Correctly states if nurse should be reported or not reported with 2 sentences.

(15 point)

Writes 1 sentence.

(10 points)

Incorrectly judges whether violations occurred (0 point)

 

Part   2

Violation of IBPR Rule 217.19 (Total   25 points)

Correctly listed the 4 violations and provides correct explanations (25 points)

Correctly lists 2-3 violations and explanations (15 points)

Lists 1 violation and explanation (10 points)

Incorrectly lists criteria (0 point)

 

All 5 questions correct (25 points)

4 questions correct (20 points)

3 questions correct (15 points)

2 questions correct (10 points)

1 question correct (5 points)

0 questions correct (0 point)

 

Part 1: (a) Applying Rule 217.16(h) Minor Incidents

Read the following scenario and then answer the questions that follow:

You are on your hospital’s Peer Review Committee (PRC). You are reviewing Nurse A’s practice. She works on the pediatric unit. In the past, Nurse A has practiced safely without incidents. However, four months ago, Nurse A gave immunizations to five pediatric patients (3 months, 9 months, 2 years, 4 years, and 5 years of age). She used a vial of Hepatitis B vaccine that had been expired for 30 days but still was being stored in the unit refrigerator. She gave the five immunizations within a few minutes of each other, and she got the vial from the refrigerator only once (i.e., She did not take it out and replace it five times). She took responsibility for the errors when she was informed by her unit manager.

Should Nurse A be reported to the BON?

 

Let’s review what deems a minor vs. a reportable (NOT minor) incident-

A minor incident is- 217.16(a)-  as defined under the Texas Nursing Practice Act, Texas Occupations Code §301.401(2), means conduct by a nurse that may be a violation of the Texas Nursing Practice Act or a Board rule but does not indicate the nurse’s continued practice poses a risk of harm to a patient or another person.

A reportable incident is- 217.16(h)- conduct that falls outside of the definition of a minor incident and must be reported to a PRC or BON.

Apply the Minor Incident Rule to reach and support your decision. This Rule 217.16 can be found at http://www.bon.texas.gov/rr_current/217-16.asp

Use this specific link only- it is the official updated Texas Board of Nursing information. Click on the link and scroll down to the bottom to find the letter (h), where criteria are listed that describes actions that must be reported to the Peer Review Committee or BON.

Criteria. In the first column of the table, list the 5 criteria as it appears in the rule that are essential in determining if an incident is a reportable action. All 5 must be listed for full credit. Then, in the second column, record your explanation as to why or why not the nurse’s actions deem it reportable and therefore harmful to a patient.

 

Criteria that determine an incident is reportable

Rule 217.16(h)

Explanation of whether or not Nurse A’s actions are minor vs. reportable

Criteria :

1.

 

2.

 

3.

 

4.

 

5.

Part 1: (b) Report vs. Not Report

Based on the Rule 217.16(h) criteria you listed above, would you report Nurse A to the Board? Please explain why or why not. At least 3 substantial sentences are needed for full credit.:       (Explain below)

 

 

 

Part 2: Applying Rule 217.19 Incident-Based Peer Review

Read the following scenario and then reflect upon the actions it portrays.:

Last month, the chairperson of your hospital’s Peer Review Committee (PRC) passed you in the hallway and said, “I’m glad I ran into you. You’re going to be peer-reviewed.” The chairperson continued, saying, “Your manager found out that you called the Texas Department of State Health Services two months ago and reported that LVNs were being allowed to do the complete initial assessment on patients. Also, you made some medication errors over the past couple of months. I’ll let you know when the meeting is to occur.”

You heard nothing more about the PRC meeting. Today, the chairperson came to you and told you that you had been reported to the Texas Board of Nursing. She said, “It was just felt by the work group that you are a troublemaker and lack the skills to practice due to your med errors. I’m also giving you a ‘heads up’ that you are going to be put on suspension for at least three days by your unit manager.”

Applying Rule 217.19, what violations of the rule occurred in the above scenario?

First, review your learning about incident-based peer review. In the first column of the table, list any 4 criteria from Rule 217.19 that were violated (there are more than 4 to choose from).

1-

2-

3-

4-

In the second column, explain how each criterion was violated. All 4 boxes must be completed for full credit. Please use the link provided at http://www.bon.texas.gov/rr_current/217-19.asp

 

Which part of the rule was violated?

(Subsection number and letter OR descriptive phrase)

(Rule 217.19)

Explanation of violation ( from the 4 criteria above):

 

1.

 

2.

 

3.

 

4.

Case Study And Moral Status

Based on “Case Study: Fetal Abnormality” and other required topic study materials, write a 750-1,000-word reflection that answers the following questions:

  1. What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?
  2. Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?
  3. How does the theory determine or influence each of their recommendations for action?
  4. What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Rubric

 

Explanation of the Christian view of the nature of human persons and the theory of moral status that it is compatible is clear, thorough, and explained with a deep understanding of the connection between them. Explanation is supported by topic study materials. 30%

The theory or theories that are used by each person to determine the moral status of the fetus is explained clearly and draws insightful relevant conclusions. Rationale for choices made is clearly supported by topic study materials and case study examples. 15%

Explanation of how the theory determines or influences each of their recommendations for action is clear, insightful, and demonstrates a deep understanding of the theory and its impact on recommendation for action. Explanation is supported by topic study materials. 15%

Evaluation of which theory is preferable within personal practice along with how that theory would influence personal recommendations for action is clear, relevant, and insightful. 10%

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Writer is clearly in command of standard, written, academic English.

All format elements are correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Here is a link to the Khan video on Moral Status. It will help explain the five theories discussed in the lecture: 

https://www.khanacademy.org/partner-content/wi-phi/wiphi-value-theory/wiphi-ethics/v/moral-status 

Culture Class Module 2 Assignment Family Traditions

Familial Health Traditions

Instructions: 

  1. Read and follow the directions on pages 160 and 161.
  2. Conduct an interview with an older family member.
  3. Summarize your findings regarding familial and social changes, and your ethnocultural and religiousheritage. (Include one example)
  4. Your paper should be:
    • One (1) page
    • Typed according to APA style for margins, formating and spacing standards
      • See NUR3045 – Library (located on left-side on menu) for tutorial Using APA Style
    • Typed into a Microsoft Word document, save the file, and then upload the file.
    • I ATTACHED THE PDF OF THE BOOK SO YOU CAN LOOK AT PAGE 160 AND 161 WHCIH IS PART OF CHAPTER 7

Professional Capstone And Practicum Reflective Journal

Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.

In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:

  1. New practice approaches
  2. Intraprofessional collaboration
  3. Health care delivery and clinical systems
  4. Ethical considerations in health care
  5. Population health concerns
  6. The role of technology in improving health care outcomes
  7. Health policy
  8. Leadership and economic models
  9. Health disparities

Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.

APA style is required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines.

MINIMUM OF 6 REFERENCES, 1500 WORDS, NO PLAGIARISM PLEASE 

Looking for someone to finish putting together my portfolio

Looking for someone to finish putting together my portfolio.  ALL papers are written and I have Portfolio started, I just need the checklist filled out and the papers matched up with the portfolio template.  I got called into work.  I NEED THIS TONIGHT so I can post it and be done prior to leaving for work.  AGAIN the template is started and the papers are written I just need it put together.  COMMENT FROM MY TEACHER:   you cut and paste the portfolios into the Professional Portfolio. In the template, there is a template/ checklist that tells you want to put into the portfolio. No Zip file, just save as a PDF and it should upload easily.

Assignment 1: Assessing The Genitalia And Rectum

IT IS A SOAP NOTE, PROFESSOR ONLY ACCEPTED CLASS RESOURCES.

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

GENITALIA ASSESSMENT

Subjective:

  • CC: “I have bumps on my bottom that I want to have checked out.”
  • HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
  • PMH: Asthma
  • Medications: Symbicort 160/4.5mcg
  • Allergies: NKDA
  • FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
  • Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

  • VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
  • Heart: RRR, no murmurs
  • Lungs: CTA, chest wall symmetrical
  • Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia
  • Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney
  • Diagnostics: HSV specimen obtained

Assessment:

  • Chancre
  • PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

To prepare:

With regard to the SOAP note case study provided:

  • Review this week’s Learning Resources, and consider the insights they provide about the case study.
  • Consider what history would be necessary to collect from the patient in the case study.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
  • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

  • Analyze the subjective portion of the note. List additional information that should be included in the documentation.
  • Analyze the objective portion of the note. List additional information that should be included in the documentation.
  • Is the assessment supported by the subjective and objective information? Why or Why not?
  • Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?
  • Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature.

CALSS RESOURCES

Learning Resources

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

Required Readings

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 16, “Breasts and Axillae” (pp. 350-369)
This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

Chapter 18, “Female Genitalia” (pp. 416-465)
In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.

Chapter 19, “Male Genitalia” (pp. 466-484)
The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.

Chapter 20, “Anus, Rectum, and Prostate” (pp. 485-500)
This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 5, “Amenorrhea” (pp. 47-60)
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.

Chapter 6, “Breast Lumps and Nipple Discharge” (pp. 61-72)
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.

Chapter 7, “Breast Pain” (pp. 73-80)
Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.

Chapter 27, “Penile Discharge” (pp. 318-324)
The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.

Chapter 36, “Vaginal Bleeding” (pp. 419-433)
In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient, as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.

Chapter 37, “Vaginal Discharge and Itching” (pp. 434-445)
This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
Chapter 3, “Adult Preventative Care Visits” (“Gender Specific Screenings”; pp. 48–49)Note: Download the Physical Examination Objective Data Checklist to use as you complete the Head-to-Toe Physical Assessment Video assignment.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

This Physical Examination Objective Data Checklist was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Cucci, E. Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/ 

Sabbagh, C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045
Retrieved from the Walden Library Databases.

Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.
Retrieved from the Walden Library databases.
This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

Centers for Disease Control and Prevention. (2012). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#

This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

University of Virginia. (n.d.). Introduction to radiology: An online interactive tutorial. Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html

This website provides an introduction to radiology and imaging. For this week, focus on genitourinary radiology, as well as the cross-sectional female pelvis and the cross-sectional male pelvis in abdominal radiology.

Required Media

Online media for Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)
Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions.

Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)
In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.

Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)
The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.

Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)

Walden NURS6521 Week 8 Quiz 2017

Question 1 A 15-year-old boy is being carefully monitored for a skin infection and is being given ciprofloxacin. The nurse will observe for which of the following?

A) Arthropathy
B) Colitis
C) Hepatitis
D) Hypotension

Question 2 A patient has been admitted to the critical care unit of the hospital with bacterial septicemia that has failed to respond to initial antibiotic treatment. The patient’s most recent blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA) in the patient’s blood. The nurse will anticipate that this patient will likely require intravenous administration of what antibiotic?

A) Vancomycin
B) Penicillin G
C) Cefazolin
D) Doripenem (Doribax)

Question 3 Mr. Laird is a 49-year-old electrician who experienced severe burns on his trunk, arms, and hands in a workplace accident 2 weeks ago. Part of his current wound care regimen involves the daily application of silver sulfadiazine to his wounds.The nurses who are providing care for Mr. Laird in the burns and plastics unit of the hospital should perform what action when administering this medication?

A) Apply a layer of silver sulfadiazine that is sufficiently thick to make the wound bed invisible.
B) Cleanse the wound of debris prior to applying the silver sulfadiazine
C) Apply a thin layer of the drug to Mr. Laird’s wound beds using clean technique.
D) Perform thorough wound care immediately after the application of silver sulfadiazine

Question 4 A patient is prescribed ganciclovir to treat a CMV infection. An oral dosage is prescribed. To help increase bioavailability of the drug, the nurse will encourage the patient to take the medication

A) with high-fat meals
B) with orange juice
C) on an empty stomach
D) with high-protein meals

Question 5 A patient has endocarditis and is taking gentamicin. The nurse will be sure to monitor which of the following?

A) Potassium level
B) Creatinine clearance
C) Serum albumin level
D) Prothrombin time

Question 6 A 30-year-old woman who is in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye that is crusted with purulent exudate. The clinician suspects a bacterial, rather than viral, etiology. How will the patient’s pregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis?

A) Ciprofloxacin is safe to use in pregnancy and the patient may use to same dose and route as a nonpregnant patient
B) The use of ciprofloxacin is contraindicated in pregnancy
C) It is safe for the patient to use topical ciprofloxacin but the oral route is potential teratogenic
D) The patient will require a lower dose and longer course of ciprofloxacin than a nonpregnant, adult patient

Question 7 A nurse has questioned why a patient’s physician has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of a patient’s infection. Which of the following facts provides the best rationale for the use of narrow-spectrum antibiotics whenever possible?

A) Broad-spectrum antibiotics confound the results of subsequent culture and sensitivity testing.
B) Narrow-spectrum antibiotics normally require a shorter duration of treatment
C) The efficacy of most narrow-spectrum antibiotics has not been proven
D) The use of broad-spectrum antibiotics can create a risk for a superinfection

Question 8 A 72-year-old patient is prescribed ophthalmic ciprofloxacin for a bacterial infection in her right eye. The nurse will teach her to observe for which of the following adverse effects of the drug?

A) Lid margin crusting and pruritus
B) Cognitive changes
C) Nephrotoxicity and neurotoxicity
D) Tendon ruptures

Question 9 A patient has been prescribed oral tetracycline.The nurse will instruct the patient to take the drug

A) on an empty stomach 1 hour before or 2 hours after taking any meals or other drugs.
B) with a meal.
C) with milk or fruit juice.
D) at bedtime only.

Question 10 A 20-year-old female patient is receiving topical clindamycin for acne vulgaris. She develops a rash and urticaria along with severe itching where the medication is applied. The nurse will formulate which of the following nursing diagnoses for the patient?

A) Diarrhea
B) Risk for Injury related to allergic reactions
C) Imbalanced Nutrition: Less than Body Requirements
D) Risk of Injury related to blood dyscrasia

drug therapy, including INH and rifampin. A priority assessment by the nurse will be to monitor which combination of laboratory test results?

A) Serum alanine transaminase, aspartate transaminase, and bilirubin
B) Red blood count, white blood count, and differential
C) Thyroid-stimulating hormone, thyroxine, and triiodothyronine levels
D) Fasting blood sugar and 2-hour postprandial blood sugar

Question 12 An immunocompromised cancer patient has developed cryptococcal meningitis and been admitted to the intensive care unit for treatment with amphotericin B. How should the nurse most safely administer this drug?

A) Hang the drug by piggyback with lactated Ringer’s and infuse over several hours to minimize the risk of infusion reaction
B) Infuse the drug over 2 to 4 hours into a central line using an infusion pump
C) Flush the patient’s central line with normal saline and infuse the amphotericin B by intravenous push over 5 to 7 minutes.
D) Place the patient on a constant infusion of amphotericin B at a rate determined by the patient’s body weight.

Question 13 A nurse is aware that the concept of selective toxicity is foundational to antimicrobial therapy. Which of the following statements most accurately describes selective toxicity?

A) A drug harms microbes without harming human cells
B) A drug’s effect on microorganisms is proportionate to dose
C) Most microbes may be collected from a host and cultured on an alternative medium
D) A drug can be isolated and produced in a controlled manner in a laboratory setting

Question 14 An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with

A) ciprofloxacin
B) clindamycin
C) vancomycin
D) an antistaphylococcic penicillin

Question 15 Laboratory testing has confirmed that a patient has chloroquine-resistant malaria and the patient’s physician has prescribed quinine along with an adjunctive drug. The nurse should question the physician’s order if the patient has a history of

A) osteoporosis or low bone density
B) chronic obstructive pulmonary disease (COPD)
C) diabetes mellitus
D) cardiac arrhythmias

Question 16 A 46-year-old man is receiving a quinupristin/dalfopristin IV infusion for a life-threatening infection. Which of the following would be most important for the nurse to monitor?

A) Increased heart rate
B) Breathlessness
C) Infiltration, edema, or phlebitis at the infusion site
D) Nausea and vomiting

Question 17 A patient with AIDS has developed a number of secondary infections in recent weeks, including Kaposi’s sarcoma. As a result of this most recent diagnosis, his care team has opted to begin treatment with interferon alfa-2a. The nurse is aware that this drug will address the etiology of Kaposi sarcoma by

A) inhibiting tumor growth by enhancing inflammation
B) potentiating the effects of phagocytes and macrophages
C) causing mutations in the DNA of cancerous cells
D) increasing the production of B cells and T cells

Question 18 Sulconazole has been prescribed for a patient with tinea pedis. The nurse will instruct the patient to use the topical agent

A) once a day
B) twice a day
C) three times a day
D) as needed

Question 19 Which of the following is critical to helping prevent development of resistant strains of microbes in patients?

A) Limit the exposure of bacteria to an antimicrobial agent
B) Keep the antimicrobial drug dosage high
C) Maintain the optimum duration of the antimicrobial agent
D) Maintain the maximum safe frequency of antimicrobial drug ingestion

Question 20 Which of the following nursing actions is most important in achieving successful antimicrobial therapy with vancomycin?

A) Provide maximum physical comfort to the patient
B) Monitor serum drug level
C) Taper down the drug dosage gradually
D) Promote adequate intake of fluids and nutrients

Question 21 A patient is being treated for Mycoplasma pneumoniae pneumonia. She is allergic to penicillin and is being given azithromycin (Zithromax) in capsule form. The nurse will inform the patient that she will need to take the capsule

A) with food
B) on an empty stomach
C) with or without food
D) immediately after she eats

Question 22 A patient is taking rifampin (Rifadin) for active TB. When discussing this drug with the patient, the nurse should stress that

A) the drug usually causes cardiac arrhythmias
B) the drug frequently causes seizure activity
C) facial flushing may appear but will go away once therapy is concluded
D) body fluids such as urine, saliva, tears, and sputum may become discolored

Question 23 A nurse is explaining the use of acyclovir therapy to a 72-year-old man. Nephrotoxicity is discussed as a major adverse effect in older patients. To minimize the risk of the patient developing this adverse effect, the nurse will advise him to

A) take the tablets on an empty stomach
B) decrease the drug dosage if initial symptoms of nephrotoxicity appear
C) stay well hydrated by drinking at least eight 8-oz glasses of water daily
D) eat light meals every day

Question 24 A 9-year-old boy was bought to his primary care provider by his mother with signs and symptoms of hookworm infection and will be sent home with a prescription for mebendazole. When provided patient and family education, the nurse should teach the mother with which of the following measures to avoid reinfection following treatment?

A) The importance of vigilant hygiene for the boy and the other members of the family
B) The need for the boy to provide serial stool samples for 6 months following treatment
C) The need to supplement the anthelminthic drug with prophylactic antibiotics
D) The need to use prescription skin cleansers during treatment and for 6 weeks after

Question 25 A nurse is caring for a patient who is on amphotericin B. On morning rounds the patient reports weakness, numbness, and a tingling sensation in his feet. What would be a priority action by the nurse?

A) Encourage the patient to increase fluid intake
B) Use strict aseptic technique for drug administration
C) Keep the bed in a low position and the side rails up at all times
D) Reduce the drug dosage

Question 26 A nurse is providing education to a patient who is taking INH. The nurse will advise the patient to avoid which of the following foods?

A) Cheese, dairy products, and bananas
B) Potatoes and root vegetables
C) Citrus fruits
D) Chicken and fish

Question 27 A child is taking permethrin for head lice. The nurse will instruct her mother to

A) wash her hair daily with a good shampoo
B) increase her daily intake of milk
C) maximize the child’s fluid intake
D) stop using creams, ointments, and oils on the child’s skin and scalp.

Question 28 A patient is receiving cefazolin in combination with anticoagulants. To minimize the adverse effects during therapy, the nurse will

A) monitor the site of injection
B) monitor the patient for bleeding gums
C) continue therapy until 2 days after symptoms have resolved
D) administer the medication with small amounts of food and fluids

Question 29 Which of the following would a nurse assess for in a patient who is taking polymyxin B systemically?

A) Peripheral neuropathy
B) Nephrotoxicity and hepatotoxicity
C) Hyperkalemia and hyponatremia
D) Endocarditis and hypertension

Question 30 A 30-year-old African-American woman tested positive for TB and is prescribed isoniazid. The nurse will plan the patient’s care to include close monitoring of the drug therapy because

A) the process of drug elimination will be faster in this patient
B) the therapeutic effect of the drug may be too slow to be effective
C) the patient is at greater risk for high serum levels of the drug
D) the process of drug metabolism may be faster in this patient

Question 31 A patient is receiving long-term clindamycin therapy for a life-threatening infection. The nurse will begin by monitoring this drug therapy by obtaining

A) blood glucose levels daily for 1 week
B) establishing the patient’s auditory abilities
C) a baseline complete blood count
D) liver enzymes weekly until the drug therapy is completed

Question 32 A 45-year-old female patient is prescribed ciprofloxacin to treat a bronchial infection. A nursing assessment revealed that she started taking daily vitamin supplements about 2 years ago. To maximize the therapeutic effects of the ciprofloxacin therapy, the nurse should advise the patient to

A) take the vitamins at least 2 hours before or after taking ciprofloxacin
B) alternate the dosage of ciprofloxacin and vitamin supplements
C) reduce the dosage of vitamin supplements
D) reduce the dosage of vitamin supplements and double the dosage of ciprofloxacin

Question 33 A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug

A) with a sip of water 1 hour before mealtime
B) immediately before or with a meal
C) with a glass of water 1 hour before or 2 hours after a meal
D) intravenously with the assistance of a home health nurse

Question 34 A 15-year-old patient has meningitis caused by Haemophilus influenzae. She is being treated with chloramphenicol. The most important nursing action for this patient would be to monitor

A) blood sugar levels daily
B) liver enzymes monthly
C) plasma concentrations regularly
D) urine output daily

Question 35 A 49-year-old farmer who normally enjoys good health has become seriously ill in recent days and the results of an extensive diagnostic work up have resulted in a diagnosis of histoplasmosis. The patient has been admitted to the hospital and has begun treatment with amphotericin B. The nurse who is providing care for the patient should prioritize which of the following diagnostic results during his course of treatment?

A) Electrolytes, blood urea nitrogen, and creatinine
B) Hemoglobin, hematocrit, and red blood cells
C) PT, PTT, and platelets
D) C-reactive protein

d

position the patient in the side-lying position.

Question

Week 6 quiz

Question 1

A 65-year-old woman has an advanced form of rheumatoid arthritis. Her treatment includes a regular dosage of methotrexate. The nurse will advise her to take which of the following vitamin supplements while taking the drug?

A) Vitamin A
B) Vitamin B
C) Vitamin C
D) Vitamin D

Question 2

To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic patient, as the patient regains consciousness, the nurse should

A) administer calcium supplements.
B) position the patient in the side-lying position.
C) administer carbohydrates.
D) monitor for nausea and vomiting.

Question 3

A female patient with a diagnosis of type 1 diabetes mellitus has been experiencing increasing neuropathic pain in recent months, a symptom that has not responded appreciably to conventional analgesics. The patient’s care provider has begun treatment with gabapentin (Neurontin). How is the addition of this drug likely to influence the management of the patient’s existing drug regimen?

A) The patient may be required to temporarily hold her other medications until a stable serum level of gabapentin is achieved.
B) It is unlikely to influence the patient’s other medications because gabapentin does not interact with other drugs.
C) Gabapentin is contraindicated with the use of exogenous insulin.
D) The patient’s medication-related risk for renal failure must be assessed prior to the use of gabapentin.

Question 4

A nurse is caring for a patient who has been diagnosed with hypothyroidism. Levothyroxine (Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for which of the following?

A) History of taking anticoagulant drugs
B) Allergy to seafood
C) Hirsutism
D) The patient’s age

Question 5

A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor which of the following?

A) Prothrombin time and partial thromboplastin time
B) Urine specific gravity
C) Alanine aminotransferase and total bilirubin levels
D) Follicle-stimulating hormone levels

Question 6

A nurse is assessing a patient who has come to the emergency department complaining of back spasms. The patient states that he has a history of opioid addiction and does not want to take any drug that “puts me at risk of becoming physically dependent.” Which of the following medications would the nurse question, if ordered?

A) Methocarbamol (Robaxin)
B) Orphenadrine (Norflex)
C) Cyclobenzaprine (Flexeril)
D) Metaxalone (Skelaxin)

Question 7

A 40-year-old woman with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize when updating the nursing care plan for this patient?

A) Risk for Injury related to CNS depressant effects
B) Diarrhea related to anticholinergic effects
C) Altered Nutrition, Less than Body Requirements, related to appetite suppression
D) Impaired Swallowing related to increased muscle tone

Question 8

A nurse is working with a 57-year-old man who is a former intravenous drug abuser. He has been prescribed a weekly dosage of methotrexate for his rheumatoid arthritis. Which of the following will the nurse include in her teaching plan for this patient?

A) Avoid high-fat foods
B) Drink plenty of water every day
C) Take the tablets before bedtime
D) Avoid red meat

Question 9

Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine?

A) The resident has not eaten breakfast because of a recent loss of appetite
B) The resident’s apical heart rate is 112 beats/minute with a regular rhythm
C) The resident had a fall during the night while transferring from her bed to her bathroom
D) The resident received her annual influenza vaccination the previous day

Question 10

A nurse is caring for a 61-year-old man who has had a severe attack of gout while in the hospital for food poisoning. The nurse administers colchicine intravenously in order to

A) avoid aggravating the gastrointestinal tract.
B) ensure quick distribution of the drug.
C) prevent the risk of infection or bleeding.
D) minimize the risk of depressed bone marrow function.

Question 11

A patient receives 25 units of NPH insulin at 7.AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?

A) After breakfast
B) Before lunch
C) Late afternoon
D) Bedtime

Question 12

A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient’s

A) blood pressure.
B) potassium level.
C) use of alcohol.
D) use of salt in his diet.

Question 13

A male patient with a diagnosis of relapsing-remitting multiple sclerosis is in the clinic to discuss with the nurse the possibility of self-administration of glatiramer. During the patient education session for self-administration, the nurse will emphasize

A) the need to rotate the injection site of the drug.
B) the need to avoid crushing the tablet.
C) the need to place the tablet under the tongue.
D) the need to use only the thigh muscle for the drug injection site.

Question 14

A diabetic patient being treated for obesity tells the nurse that he is having adverse effects from his drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which of the following adverse effects would need the nurse’s immediate attention?

A) Decreased libido
B) Increased blood glucose
C) Dry eyes
D) Jittery feeling

Question 15

A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an expectorant). What special instructions should the nurse include in the patient teaching for this situation?

A) Wash hands before and after taking the medicine
B) Keep track of any gastrointestinal tract infections
C) Monitor glucose levels closely
D) Note the time the medicine is taken each day

Question 16

A 13-year-old patient has juvenile arthritis. He has recently had oral surgery and was told by the surgeon to take aspirin for the pain. The nurse will monitor for which of the following?

A) Bronchoconstriction
B) Hepatotoxicity
C) Aplastic anemia
D) Agranulocytosis

Question 17

A nurse has been invited to speak to a support group for persons with movement disorders and their families. Which of the following statements by the nurse addresses the chronic nature of these diseases and the relevant drug therapies?

A) “Drug therapy can consist of one or more drugs to eliminate the symptoms of these diseases.”
B) “Drugs do not cure these disorders; they instead enhance quality of life.”
C) “Persons of all cultures are treated similarly and respond in similar ways to treatment.”
D) “Drugs used to treat these disorders always pose a risk of severe liver and kidney dysfunction.”

Question 18

A patient in need of myocardial infarction prophylaxis has been prescribed sulfinpyrazone for gout. Which of the following will the nurse monitor the patient most closely for?

A) Hypothermia
B) Hypotension
C) Renal dysfunction
D) Bleeding

Question 19

A nurse is developing a care plan for a patient who has multiple sclerosis. An expected outcome for the patient who is receiving glatiramer would be a decrease in

A) chest pain.
B) fatigue.
C) breathing difficulties.
D) heart palpitations.

Question 20

A 32-year-old female patient is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the patient and her husband that the adverse effect that poses the greatest safety risk to the patient is

A) constipation.
B) dry mouth.
C) fatigue.
D) hypotension.

Question 21

A 34-year-old male patient is prescribed methimazole (MMI).The nurse will advise him to report which of the following immediately?

A) Vertigo
B) Intolerance to cold
C) Loss of appetite
D) Epigastric distress

Question 22

A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium).In light of this new addition to her drug regimen, what teaching point should the woman’s nurse provide?

A) “This will likely relieve your muscle spasms but you’ll probably develop a certain amount of dependence on the drug over time.”
B) “We’ll need to closely monitor your blood sugar levels for the next week.”
C) “There’s a small risk that you might experience some hallucinations in the first few days that you begin taking this drug.”
D) “You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity.”

Question 23

A patient with type 1 diabetes has been admitted to the hospital for orthopedic surgery and the care team anticipates some disruptions to the patient’s blood glucose levels in the days following surgery. Which of the following insulin regimens is most likely to achieve adequate glycemic control?

A) Small doses of long-acting insulin administered four to five times daily
B) Doses of basal insulin twice daily with regular insulin before each meal
C) Large doses of rapid-acting insulin combined with long-acting insulin each morning and evening
D) Divided doses of intermediate-acting insulin every 2 hours, around the clock

Question 24

During long-term desmopressin therapy in a 48-year-old woman, it will be most important for the nurse to assess which of the following?

A) The patient’s environment
B) The patient’s diet
C) The condition of the patient’s skin
D) The condition of the patient’s nasal passages

Question 25

A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to

A) crush the tablet before swallowing.
B) swallow the tablet whole.
C) swallow the tablet with milk or food.
D) avoid drinking milk for 3 hours after swallowing the tablet.

Question 26

A nurse will instruct a patient taking allopurinol to take each dose

A) at night.
B) first thing in the morning.
C) after a meal.
D) before a meal.

Question 27

The nurse is conducting a medication reconciliation of a new resident of a long-term care facility. The nurse notes that the resident takes allopurinol on a daily basis for the treatment of gout. What is the primary purpose of this drug?

A) To balance urate concentration and prevent gout attacks
B) To promote the remodeling of damaged synovium
C) To potentiate the metabolism of dietary purines
D) To achieve pain relief in joints affected by gout

Question 28

A nurse is teaching a patient about his newly prescribed drug, colchicine, for gout. The nurse will instruct the patient to avoid which of the following foods?

A) Green beans
B) Shrimp
C) Eggs
D) Milk

Question 29

A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which of the following instructions?

A) Eat a high-protein diet
B) Decrease the dosage if any adverse effect is experienced
C) Wear appropriate clothing and sunscreen whenever he is in direct sunlight
D) Have a complete blood cell count done weekly

Question 30

A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When developing a care plan for this patient, which factor will be most important for the nurse to consider?

A) Dietary habits
B) Work environment
C) Typical daily fluid intake
D) Ethnicity