Final Exam Flashcards by Maressa Cooley

Sandra is 42 years old and has just been diagnosed with leukemia. She is complaining of bone and joint pain. Which type of leukemia is most likely the culprit?

Acute myelogenous leukemia

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During treatment for anaphylaxis, which site is used for the initial injection of epinephrine?

Upper lateral thigh

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After the initial treatment for anaphylaxis, which medication should be added to prevent late-phase anaphylactic reactions?

Corticosteroid

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Which statement about HIV postexposure prophylaxis (PEP) for health-care workers is the most accurate?

PEP should be started within 72 hours of exposure OR hours idk which.

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Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate?

A favorable prognostic trend

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If the INR result is above the therapeutic range in a patient with atrial fibrillation on warfarin, what might the clinician do?

Withhold 1 or more days of anticoagulant therapy.

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In the United States, what is the second most common connective tissue disease and the most destructive to the joint?

Rheumatoid Arthritis

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Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process?

C-reactive protein (CRP)

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Which condition is the most common cause of generalized musculoskeletal pain in women ages 20 to 55?

Fibromyalgia syndrome

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After returning from visiting his grandchildren in Connecticut, George, age 59, complains of a flu-like illness, including fever, chills, and myalgia. He reports having discovered a rash or red spot that grew in size on his right leg. Which disease should the clinician be considering?

Lyme disease

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The most cost-effective screening test for determining HIV status is which of the following?

Enzyme-linked immunosorbent assay

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Spontaneous bruising may be seen with platelet counts below what level?

30,000 cells/mL

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Early rheumatoid disease is characterized by?

Joint swelling and immobility on rising

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Which test is diagnostic of RA?

Anti-citrulline-containing peptide titers

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The exanthem of Lyme disease is?

Erythema migrans “bulls-eye”

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Keratoconjunctivitis sicca is a classic sign of which condition?

Sjögren’s syndrome

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The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least:

6 months

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A patient presents to the clinician after experiencing four episodes in the last month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted about 10 minutes. The patient is now becoming very fearful of future events and has been reluctant to leave the house. The clinician suspects panic disorder but wants to rule out any possible medical causes. Which of the following medical conditions can mimic the symptoms of a panic attack?
A. Pheochromocytoma
B. Hyperthyroidism
C. Cardiac arrhythmias

All the above

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Which of the following is considered first-line treatment for panic disorder?

Cognitive-behavioral therapy

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Which of the following symptoms is NOT part of the diagnostic criteria for post-traumatic stress disorder (PTSD)?

Hypersomnolence

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The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is NOT true concerning SSRIs in comparison to tricyclic antidepressants?

SSRIs are more effective than TCAs.

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It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period?

As the mood lifts in response to antidepressant treatment

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According to Kübler-Ross, the stages of grief occur in which order?

Denial, anger, bargaining, depression, acceptance

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The clinician is educating a patient about the effects of marijuana. The patient stated that she has been smoking for years and believes the use does not interfere with her life. What is the potential long-term sequelae of marijuana use that the clinician should educate this patient about?

Memory impairment

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Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter?

Dopamine

What blood alcohol level corresponds with the signs of stupor and confusion?

0.3

It is important for the clinician to discuss the long-term effects of sexual assault with survivors. Which of the following is the most common long-term effect of sexual assault?

PTSD

Women are at the highest risk for developing peripartum depression for up to how long after childbirth?

1 to 3 weeks

Which is the most prevalent psychiatric condition in the United States?

Anxiety

Which type of heat-related illness involves a core body temperature of at least 104°F and may present with hot dry skin, acute mental status changes, absent sweat, and tachypnea?

Heatstroke

Assessing for adherence to prescribed medications and developing a plan for what to do if they are stopped is a major treatment issue for which of the following diagnostic groups?

Bipolar

Which drug commonly prescribed for burns is active against a wide spectrum of microbial pathogens and is the most frequently used agent for partial- and full-thickness thermal injuries?

Silver sulfadiazine (Silvadene)

What is the normal number for the Glasgow Coma Scale?

Which diagnostic test is the best to diagnose a subdural hematoma?

MRI

Which clinical feature is to be affected in increased intracranial pressure?

Decrease in LOC

Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point?

30% to 50%

Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue?

Brown recluse spider

Which of the following characteristics separates anaphylaxis from a vasovagal reaction?

Insect sting

Delayed serum sickness–type reactions in response to multiple bee, wasp, or fire-ant stings can be managed with which of the following?

A corticosteroid such as prednisone (Deltasone), 60 to 100 mg, tapered over 2 weeks

A patient with a basilar skull fracture may experience an impaired downward gaze or diplopia from which affected cranial nerve?

CN IV

Which classic feature of an epidural hematoma may distinguish it from other skull hematomas?

brief loss of consciousness, then a brief “lucid” moment, followed by momentary unconsciousness minutes after the injury

Josie, age 30, has a pneumothorax. It may be treated conservatively without a chest tube if it is deflated by what percentage?

30%

Pink, cherry-red tissues and skin may result from which type of poisoning?

Carbon monoxide

In which type of burn is the injury more extensive than it appears, and the cardiac conduction system may be affected, leading to sudden death or arrhythmias?

Electrical burns

A cerebellar function may be assessed by performing which examination/test?

Romberg test

Which of the following statements is true about antibiotic prophylaxis for most wounds?

Antibiotics are not indicated.

Which of the following statements is TRUE regarding pain?

Nociceptive pain represents a normal response to injury of tissue.

Which of the following would be a cause of visceral pain?

Abdominal Cavity, blockage of intestines.

A 75-year-old man is being treated as an outpatient for metastatic prostate cancer. Which of the following statements is true regarding the management of pain with opioids in the elderly?

None of the above

A patient had a transdermal fentanyl patch placed 2 hours ago and is not getting any pain relief. What would be the most appropriate intervention?

prescribe a short-acting opioid for breakthrough pain

A patient is preparing to be discharged home with hospice. She is on morphine PCA in the hospital. She is concerned as to whether she can stay on her PCA at home even when she is not able to give herself boluses. What would be the appropriate response of the clinician?

"It would be possible for your nurse or another trained family member to activate the dosing button when you are unable to do so"

If a patient is requiring six rescue doses for breakthrough pain in a 24-hour period, what would be an appropriate intervention?

Increase the dose of the baseline long-acting medication

A pt with bone metastases from prostate cancer is inquiring whether he is a candidate for radiopharmaceutical. Which of the following conditions would exclude him as a candidate?

Pathologic fracture

Which of the following is the best description of dyspnea?

A subjective feeling of breathlessness

What would be an appropriate dose of morphine to give an opioid-naive patient to manage tachypnea associated with dyspnea?

15 mg PO every 4 hours

Glycopyrrolate (Robinul) is one drug of choice to manage which of the following conditions that can contribute to dyspnea?

copious secretions

which characteristic of delirium helps to distinguish delirium from dementia?

abrupt onset

which of the following classes of drugs should be used as first-line therapy for the treatment of delirium?

antipsychotics

which of the following is a role of an advanced practice nurse in palliative cancer care?

All the above ( detecting, identifying, and arranging)

Which statement about the American Nurses Association Code of Ethics is accurate?

The Code sets forth the values and ethical principles that guide clinical decisions.

Which ethical principle reflects respect for all persons and their self-determination?

Autonomy

In an outpatient setting, what is the most common reason for a malpractice suit?

Failure to diagnose correctly

Which type of liability insurance covers only situations in which the incident occurred and the claim was made while the policy was in effect?

Claims made policy

Which insurance plan was the first to allow members to choose nurse practitioners as their primary care provider and pay them the same rate as physicians for the same care?

Oxford Health Plan

When may confidentiality be overridden?

Conflicts with patient's rights, suicide, or to protect the patient. Conflicts with an innocent third party; e.g. battered child. Conflicts with rights and safety of the society. `

Constructing a decision tree is helpful in analyzing ethical dilemmas, because decision tree:

Allows all options to be considered

In the model for future Advanced Practice Registered Nurse (APRN) practice, what does the “C” of LACE represent?

Certification

The main mechanism for avoiding a lawsuit involves:

Open communication

The Nurse Practice Act of each state is responsible for?

Establishing legal standards

A situation that requires informed consent involves?

Invasive procedures

What ethical principle is the foundation on which healthcare rests?

Nonmaleficence

An APRNs scope of practice includes all of the following statements EXCEPT:

Each APRN defines his or her own aspect of practice to be included in a protocol.

Which board administers and defines advanced nursing practice in all states?

It is different for each state.

Three components must be present to establish malpractice. Which does NOT apply?

The APRN must be paying for the services in question.

Identify one of the primary reasons for an APRN to develop a business plan:

To identify the marketing needed to grow the APRN practice

Despite the growth in the numbers of APRNs over the last decades, the role of the profession is often not understood by the public. What actions should APRNs undertake to market their services to the public?

Personally seek out the news media to communicate their value.

Current procedural terminology (CPT) coding offers the uniformed language used for reporting medical services and procedures performed by physician and nonphysician practitioners. Clinicians are paid based on calculated resource costs that, in turn, are based on practice components. Which of the following is a part of the components used to calculate the per CPT code payment rate?

Clinician practice liability and malpractice expense

Beginning in 2014, all medical practices will be required by the CMS to adopt a certified electronic medical record software system for documenting and billing for medical services. What is a primary reason for this implementation mandate?

Reduces the duplication of services noted in the current system

All healthcare practices should develop a compliance plan. Compliance plans offer practice safeguards that prevent which of the following?

Conflict of interest claims

Clinicians who learn how to code and document Evaluation and Management and clinician services will be more successful in gaining timely payment for care delivery. Which of the following CMS practices is designed to financially penalize clinicians who do not bill according to CMS guidelines?

Audits and probes

Identify the primary challenge for insurance carriers in today’s health delivery model.

Reducing health-care spending

Medicare benefits were offered to U.S. beneficiaries beginning in 1965. What was the service added with the Medicare D plan in 2006?

Pharmaceutical coverage

According to the World Health Organization data on 1,500 patients around the world, how many patients present with psychiatric problems?

25% of all patients

Integrating mental health techniques and approaches, such as the 15-minute hour, into the primary-care patient encounter is important for a number of reasons. These include:

Encouraging coping strategies and increasing professional satisfaction

Commonalities among psychotherapeutic techniques include the following:

Obtaining external perspective and participation in a helping relationship

The goals of the 15-minute hour approach include:

Enhance self-esteem, expand behavioral repertoire, prevent dire consequences, and reestablish premorbid levels of functioning

The World Health Organization defines self-care as:

A set of deliberate actions that all individuals, families, and communities should engage in to maintain good health

Nurse theorist Dorothea Orem defines self-care activities as:

Comprising activities that are performed independently by an individual to promote and maintain well-being throughout life

Self-care and personal development are built into the standards of practice of:

The American Holistic Nurses Association

There are many pressures inherent in primary-care practice today for APRNs. These pressures include all of the following:

Patient-care outcomes being tied to reimbursement, role diffusion with physicians and physician assistants

A new era of health care leads to:

Greater opportunity for independent practice, yet increased legal risk in accountability for patients

Compassion fatigue is another side effect of today’s healthcare delivery system. This term means:

The APRN feels sudden guilt and distress when he or she cannot rescue or save an individual, such as when bad health habits persist despite the best efforts of the APRN.

Another term used, burn out, is differentiated by:

A gradual response to the inability to achieve one’s goals with patients in the work setting; it is characterized by frustration and diminishing morale

The following statement is TRUE:

APRNs are often sensitive to patients’ deficiencies but not their own.

The term resilience implies:

Response to difficult and adverse circumstances through positively adjusting to stressors

Qualities associated with resilience include:

Hope, self-efficacy, and positivity.

Patsy, a 42-year-old experienced APRN, is orienting a new APRN to the Minute Clinic, where she has worked for more than 5 years. Patsy loves her work and was concerned when the new APRN, Sue, expressed her dissatisfaction with this setting. “I hate the idea of being here on my own, with no backup and support after orientation” was one of Sue’s concerns. Sue confessed that this was the only job she could find. Patsy felt good in her independent role and felt she had worked to create a positive atmosphere for her patients at all times. She derived joy and satisfaction from her ability to do this for her patients. Patsy found Sue’s endless complaints debilitating. Patsy demonstrated resiliency by using which of the following strategies?

Patsy openly shared her positive feelings about the work environment and took a risk by sharing with Sue that she found her endless complaining draining.

The qualities of resilience that Patsy demonstrated when responding to Sue include:

Asserting her positive approach and basic optimism by initiating an honest discussion with Sue and having the emotional insight to recognize Sue’s negative effect on her

According to nurse theorist Jean Watson, a focus on positive intentionality—holding caring thoughts, loving kindness, and open receptivity—enhances caring energy, which leads to healing. How can the APRN bring this to their practice?

Spiritual readings, centering oneself before patient encounters, engaging in behaviors that help build positive energy