APRN begins to overly identify with pain and suffering of patients; skips lunch, trouble concentrating, nightmares A. depression B. compassion fatigue C. anxiety D. empathy - ANSWER B. compassion ... fatigue Patient with chronic bowel disease has developed persistent diarrhea, treatment most indicated to treat is: A. loperamide B. codeine C. diphenoxylate D. methylcellulose - ANSWER A. loperamide- indicated for nonspecific diarrhea but should be avoided if gross bloody stool or temp above 101 degrees or if C. diff expected. 4mg initially, then 2mg after each loose stool, NTE 16mg/day. When utilizing the SPIRIT pneumonic, as a spiritual assessment tool for a hospice patient, the first question to ask for "S" part is: A. does spirituality play a part in your personal life? B. restrictions that affect healthcare decisions? C. how does faith affect how you feel about death? D. do you have a normal religious affiliation? - ANSWER D. Spiritual: formal religious affiliation? Personal: practices/beliefs, daily life? Integration: spiritual community Ritual: specific practices that affect healthcare Implication: aspects of care to keep in mind Terminal events: does faith affect feelings about death? Obese patient, diabetes; underwent surgery for bowel obstruction 6 days ago and has persistent N/V. Feels "popping" sensation at incision site-->intestinal evisceration. Initial response: A. administer opioid, no intervention B. semi-fowler's knees up, notify surgeon C. explain what is happening, ask for guidance D. supinate patient, cover with dry sterile gauze - ANSWER B. INITIAL RESPONSE: notify surgeon Next- cover sterile soaked gauze, IV site, O2 76 year old female, generally good health, new pathologic fracture of proximal femur. pt states it occurred while walking- most likely cause: A. abuse B. multiple myeloma C. osteoporosis D. bone cyst - ANSWER C. osteoporosis- DEXA scan gold standard; T-score -2 indicates osteoporosis When collaborating with patient and family on POC, it's important for them to understand: A. rights and responsibilities B. limitations C. organizations philosophy D. difference between goals and objectives - ANSWER A. rights and responsibilities- ask them what goals and expectations are, what is important to them Native American patient, stage IV multiple myeloma, on hospice in extended care facility. Reportedly little pain AEB does not request medicine but does lay in fetal position and refuses food and fluids. APRN should advise nursing staff: A. pt probably comfortable without pain medication B. pt may avoid outward expressions of pain C. staff nurse should be more aware of pt needs D. pt probably prefers to suffer than take medications - ANSWER B. pt may avoid outward expressions of pain, but his body language indicates otherwise Middle Eastern hospice pt, cared for at home by sisters and daughters. On exam, rows of circular slightly reddened areas up and down back. Most appropriate response: A. notify APS of abuse B. tell family hospice pts cannot receive cupping C. acknowledge use of cupping D. provide supportive care for pressure sores - ANSWER C. acknowledge cupping- ancient form of healing that releases toxins Pt with progressive onset MS has chronic bladder dysfunction with spasms, frequency, incontinence. He takes ER oxybutynin. Which dietary restrictions should APRN advise? A. simple carbs B. citrus fruits C. apples and apple juice D. caffeine and alcohol - ANSWER D. caffeine and alcohol are bladder irritants and promote diuresis Family reports patient has not attended mass in 50 years. Pt is nearing death but remains responsive and not requested priest. APRN should: A. assume pt will not want to see a priest B. ask priest on call to visit C. ask the patient if he/she wants to see a priest D. ask the family if priest should be called - ANSWER C. ask the patient, never make assumptions When educating a patient or family about disease or treatment, the first step is to begin by assessing the patient's: A. emotional status B. knowledge base C. experience D. physical condition - ANSWER B. knowledge base- first assess by asking "can you tell me what you know about your illness"? Indications that the spouse of a patient who died is suffering from traumatic grief include prolonged period (>60 days): A. expressing anger, bitterness, blame regarding the death B. decrying negative habits of deceased (smoking, drinking) C. focusing on occupational role D. talking frequently about the deceased - ANSWER A. expressing anger, bitterness, blame regarding death --> also indications include avoiding talking about deceased, avoiding occupational/social roles, assuming some bad habits of the deceased A family member is concerned about the "death rattle" exhibited by a patient. When discussing administration of antimuscarinic agents such as glycopyrrolate, what possible adverse effects should be considered? A. increased sedation, delirium, xerostomia B. prolonged suffering, inability to communicate C. insomnia, depression, anxiety D. excessive sedation, respiratory depression, itching - ANSWER A. increased sedation, delirium, xerostomia When conducting a review of the literature as part of evidence based research, the level of evidence that is based on a quasi-experimental study such as a matched case control study would be categorized as: A. level I B. level II C. level III D. level IV - ANSWER C. Level III Level 1- meta analysis Level 2- well designed, may or may not be randomized Level 3- case control, quasi experimental study Level 4- comparative non-experimental Level 5- case reports without evidence A patient has osteomyelitis and an open draining wound in the proximal anterior thigh with copious amounts of purulent drainage. The wound has been requiring dressing changes 4-5 times per day. The effective method for managing the wound care is: A. apply alginate packing B. apply a pouch (such as a Hollister Wound Manager) C. utilize negative pressure wound therapy D. applying absorptive dressings with cellulose fibers - ANSWER B. apply pouch such as hollister wound manager- change Q4-7 days A female patient who has undergone surgery, radiotherapy, and chemotherapy for breast cancer has lost her hair but states she cannot afford to buy a wig. Which organization can you refer to for financial assistance? A. songs of love foundation B. assoc of cancer online resources C. cancer care D. american cancer society - ANSWER D. American Cancer Society According to the American Geriatrics Society Guideline for the Prevention of Falls in Older Persons, if a patient has had one fall in the previous year: A. the patient should be assessed for gait and balance B. no further assessment is needed C. a full assessment including vision, joint function, mental status, neuro status should be carried out D. refer to geriatric specialist - ANSWER A. Assess for gait and balance including the Get up and Go Test. Only multiple falls should elicit a full assessment If a patient receiving abdominal radiation has 7-9 loose stools daily with severe cramping and some incontinence, according to the National Cancer Institute Scale of Severity of Diarrhea, the pts score would be: A. 1 B. 2 C. 3 D. 4 - ANSWER C. 3 Score 0: normal stools Score 1: 2-3 above normal, no other sx Score 2: 4-6 above normal, nocturnal, abd cramps Score 3: 7-9 above normal, severe cramping/ incontinence Score 4: 10+ above normal, grossly bloody stools, need for parenteral support A palliative care patient with MS is increasingly immobile and spends most of the time in bed. Which of the following scores (range 6-23) on the Braden Scale is the breakpoint for risk of pressure ulcer? A. less than 8 B. less than 12 C. less than 16 D. less than 18 - ANSWER C. Less than or equal to 16 Score of 23 indicates minimal risk and 6 indicates a strong likelihood of developing pressure ulcers. A 68 year old patient has appeared depressed so APRN assesses using Geriatric Depression Scale which comprises 15 questions. How many "yes" answers are needed to indicate depression? A. 4 B. 6 C. 8 D. 12 - ANSWER B. 6 yes answers indicate depression. Tool can be used with normal cognition and mild to moderate cognitive impairment. When conducting the H&P of a military veteran who served in Vietnam, which concern applies to this specific group of vets? A. PTSD B. Shrapnel injuries C. Substance abuse D. Agent Orange - ANSWER D. Agent Orange- known teratogenic effects including leukemia and Hodgkins lymphoma, type 2 DM, ischemic heart disease, parkinson's, peripheral neuropathy. If a dying person tells you she has been seeing her mother who is deceased for many years, what is the appropriate response? A. Does seeing your mother comfort or frighten you? B. You're just dreaming C. I'm sure your mother is watching over you D. It's probably because of the medicine - ANSWER A. Does seeing your mother comfort or frighten you? Which of the following unique needs may need to be addressed in the POC for homeless patients? A. fall and dysphagia precautions B. PTSD C. lice and malnutrition D. drug seeking behaviors - ANSWER C. Lice and malnutrition Patient who completed a course of mantle radiation for Hodgkins disease 20 yrs ago has developed increasing weakness and SOB on exertion. Because of previous radiation, patient is especially at risk for: A. pancreatic CA B. breast and lung CA C. liver CA D. colon and rectal CA - ANSWER B. breast and lung cancer- pts with Hodgkins have 17% risk of developing another malignancy including increased risk of leukemia with onset often within 4 years APRN started support group for pts with Parkinsons to help with coping and delay progression. APRN is facilitator, this type of preventive program is: A. primary B. secondary C. tertiary D. quaternary - ANSWER C. Tertiary Primary- prevent disease occurrence (no smoking, seatbelts, vaccinations) Secondary- identify and reduce impact (screenings, BP) Tertiary- prevent/delay disease progression 17 yr old with AIDS and pneumonia is medically unstable and his parents have broached the topic of EOL decisions with him; pt refusing to discuss the issue stating he is "not going to commit suicide". APRN advises parents to: A. remain supportive and wait for pt readiness to discuss EOL B. explain difference between EOL decisions and suicide C. urge the pt to participate in some decision making D. tell the pt they will make the decisions for him - ANSWER A. Remain supportive and wait for patient readiness to discuss EOL. 15 yr old pt with leukemia tells APRN that she wants to fill out a living will so her parents will not have to make EOL decisions for her. A document appropriate for adolescent patients: A. Five Wishes B. Voicing My Choices C. My Wishes D. Willmaker Plus - ANSWER A. Voicing My Choices- 48 yr old with myasthenia gravis had been fairly stable but after a recent bout of gastroenteritis, pt experienced marked weakening of the muscles. Tachypnea, single breath count test result of 14 (normal 50) , SpO2 95%. This likely indicates: A. normal respiratory status for MG B. atelectasis C. pneumonia D. impending respiratory failure - ANSWER D. Impending respiratory failure- An illness like gastroenteritis can trigger a myasthenia crisis which can severely impair respiratory function. O2 sat can remain normal until situation is critical. Hospice patient receiving PO morphine to control pain of pancreatic cancer reports little relief so ketamine was ordered in addition along with lorazepam once or twice daily. When ketamine is administered, the dose of the opioid should: A. be reduced by 25 to 50% B. remain unchanged C. be increased by 25% D. be increased by 50% - ANSWER A. Be reduced by 25 to 50%- An initial test dose of 25mg is often given and then the dosage is titrated upward until relief of pain is achieved. If PO or SL, doses may be taken 3-4 times daily. Continuous infusions are often used for SC or IV dosing. Hospice pt asking for overdose to cause her death because she is tired of suffering. Most appropriate response: A. It's illegal to give overdoses B. You don't really mean that C. Let's work together to better control your pain D. You should talk to your doctor about that - ANSWER C. Let's work together to better control your pain 26 yr old male with no advance directive suffered a TBI and is in a vegetative state on life support. Pts mother, sister, best friend and fiancee are present. Which person can legally make the decision to withdraw life support? A. Friend B. Sister C. Mother D. Fiancee - ANSWER C. Mother- If he was married, spouse, adult children, parents, then siblings. The principle of the double effect refers to the idea that: A. drugs may not be used to control pain if they hasten death B. drugs may be used to control pain even if they hasten death C. drugs should not be administered in order to hasten death D. drugs can be administered in order to hasten death - ANSWER B. Drugs may be used to control pain even if they hasten death, as the intent is not to hasten death but to relieve suffering. Pt with ALS is no longer able to breathe independently and has elected to be extubated, understanding that this will lead to death. In addition to an opioid to relieve dyspnea, which other medication is usually administered? A. benzodiazepine B. antipsychotic C. SSRI D. atypical antipsychotic - ANSWER A. Benzodiazepine to relieve anxiety. Pt with ESLD has made the decision to VSED to hasten death, and the pts family is supportive of this decision. Which action should the APRN take? A. notify APS B. provide supportive care C. advise the pt that VSED is an act of suicide D. discontinue services to the pt - ANSWER B. Provide supportive care. 50 yr old pt receiving chemo complains her biggest problem is managing her home and family while dealing with fatigue. Which of the following referrals would most benefit the pt? A. nutritionist B. PT C. psychologist D. OT - ANSWER D. Occupational therapist may be able to assist with strategies to manage fatigue while still being able to care for her family. APRN notes a team member usually prefers to work alone and makes excuses for not delegating more of his workload. The team member frequently takes overtime shifts when the unit is shorthanded but is increasingly short tempered and c/o fatigue and headaches. The team member is likely to experience: A. burnout B. advancement C. ostracism D. injury - ANSWER A. Burnout When educating an 80 yr old pt about self care and pain control, the teaching strategy most useful is to: A. review study skills B. allow ample time for learning and practicing C. utilize role-playing D. utilize problem-centered learning - ANSWER B. Allow ample time for learning and practicing. Also spending time getting to know the patient, eliminating non-essential info, remain patient and supportive, provide written materials. APRN has accepted a position in a different hospital and is in the "being" stage of role transition after 6 months. This stage is characterized as: A. emotional lability and recognition of limitations B. acceptance of the new role C. increase in knowledge and self-doubt D. limited problem solving skills - ANSWER C. Being stage Doing (3-4 mo)- transition shock with emotional lability and self doubt. problem solving limited. Being (4-5 mo)- transition crisis, knowledge increases along with self-doubt; stress but increased awareness, feeling unprepared for clinical situations Knowing (3-4 mo)- acceptance of the new role and recovering from some of the problems and stresses of earlier stages A pt with COPD is recovering from PNA and has spent much of the day in bed with curtains drawn and appears to have been crying. The most appropriate response is: A. you seem upset B. why are you crying C. please tell me what is bothering you D. i'm sure everything will be ok - ANSWER A. You seem upset- this is the most empathetic response, recognizes feelings without prying. Allows pt time to respond. When the APRN(sender) is talking (transmission) and giving information (message) to a patient (recipient), communication is most dependent on the: A. situation B. sender C. message D. recipient - ANSWER D. Recipient must be motivated to receive the message and must have no barrier like hearing impairment or emotional upset that interferes with the transmission. Ability to comprehend then depends on many complex factors. barrier to effective communication: A. nervous and speaks high pitch B. cheerful voice C. rubs hands together when speaking D. leans toward patient when speaking - ANSWER communication style includes "I" statements and asks for opinions such as "How do you feel about that?" is: A. passive B. aggressive C. neutral D. assertive - ANSWER rifampin - ANSWER alleviates pruritus in liver disease- also could use dronabinol, UVB therapy, naloxone initial treatment for chronic mild to moderate osteoarthritis - ANSWER acetaminophen 4g/day; avoid NSAIDs if possible only for severe pain; intraarticular injections for refractory cases opioid induced constipation - ANSWER combo stimulant and stool softener; avoid bulk laxatives if poor fluid intake signs/sx of intestinal obstruction from cancerous lesion at duodenum - ANSWER copious amounts of undigested food emesis, splashing sounds in LUQ, generally absence of pain or distension pleurX catheter drain limit at home - ANSWER 2000cc consideration of lymphadema s/p mastectomy - ANSWER infection control (most common complication)- examine arm often, avoid lab draws, tight clothing pressure ulcer dressing overview - ANSWER Hydrogel- good for small drainage, NOT large amounts etoh clearance - ANSWER 20mg/dL per hour Ex. 70kg patient with BAC 140mg/dL would take approx 7 hours to metabolize alcohol NYHA classification - ANSWER I- essentially asymptomatic during normal activity, good prognosis II- sx w/some exertion, usually absent at rest, good prognosis [Show More]
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