final exam

Question 1

Routine admit

Answer 1

planned
scheduled in advance
Example: knee replacement surgery
scheduled inductions

Question 2

Emergency admit

Answer 2

Not planned

Occur because of an injury, sudden change in condition, need for immediate treatment

Question 3

Nursing assessment

Answer 3

Vital signs, height and weight
Medications and allergies
ID for the patient and explaining pt. verification
Instruction on collecting urine for measurement etc.
Bathing and walking assistance

Question 4

Dehumization

Answer 4

Process of depriving a person of personality, spirit, privacy and other human qualities.

Handle procedures and questions with the utmost tact and respect.

Emphasize the clients strengths rather than weakness.

Question 5

Discharge Planning

Answer 5

Process by which the client is prepared for continues care outside the healthcare facility.
Arranged by discharge planner (LPN or RN)
Discharge planning starts as soon as the patient is admitted.
Discharge must be ordered by the physician
The plan takes TEAMWORK.
Teamwork is often planned out in meetings
Physicians office should receive the discharge plan and instructions

Question 6

discharge components

Answer 6

Follow up care
Equipment needed: Walker, Wheelchair, Oxygen etc.
Special Diet
Medications: New, Same or D/C
Special procedures
Family willingness
Referrals
Special instructions
Documentation of what was taught and what was understood

Question 7

Physicians office should Know

Answer 7

Time frame of follow up care
1 week, 2 weeks, etc.
Diagnosis or reason for hospital stay
Change in medications
Procedures or follow up tests ordered.
Any dietary restrictions
Dressing changes,
Referrals for home care, hospice care etc.
Special instructions

Question 8

advance directive

Answer 8

Provides an opportunity for clients to determine in advance their wishes regarding life sustaining treatment and other medical care so that their significant others will know what decisions clients desire. 
Three types:
Living will
DPOA for Healthcare
Five wishes

Question 9

six c’s

Answer 9

Clear
Coherent
Concise
Correct (accurate statements)
Courteous
Confident

Question 10

effective communication

Answer 10

Choose the correct medium
Understand the reason for the communication
Outline what you want to accomplished
Outline the benefits of a response
Create credibility and acknowledge respect for the person receiving the communication

Question 11

how do you send mail with letter of termination

Answer 11

certified

Question 12

if you make a mistake/error in documentation how do you correct it

Answer 12

single line intial and date

Question 13

Advantages of the EHR

Answer 13

Can flag the patient for recall
Files retrieved more quickly
Takes up less space
Analysis reporting is easier
Charts are not misplaced

Question 14

Cost vs savings

Answer 14

Improves diagnosis coding and procedure coding
Reduces labor – staff does not have to pull chart and re-file it
Lowers malpractice premiums
Storage space dramatically reduced
Supplies reduced – charts, labels, etc.

Question 15

How long do you keep a record for

Answer 15

7 years in Michigan – Statute of Limitations
5 years after the patient dies
Usually the chart is moved to a “deceased” area

Question 16

what is profession

Answer 16

Is an act of declaring belief, faith, or opinion requiring special knowledge or training.
Professional standing can not take place without training, practice administration and recognition by qualified state approved agencies and governing bodies.
Professionalism can be thought of a distinctive way of providing a service that has its own science of reasoning and practice.

Question 17

what is occupation

Answer 17

provides a product or service.

Question 18

what is the shorter version of profession

Answer 18

service has science of reasoning, formal training, certification, or license.

Question 19

relationship stops when the pt hasn’t been seen in

Answer 19

three years

Question 20

3 most important factors in health care are

Answer 20

Cost
Quality
Access

Question 21

frazzled employee

Answer 21

“An employee who argues with a demanding patient not only upsets the patient more, but also becomes just as tense and out of control. An employee must be able to adapt to various situations that arise in a medical office” (Andress, 2009, p. 40).

Question 22

types of ambulatory health care

Answer 22

Private clinics
Urgent care centers
Rural Health Services
Ambulatory Surgery Centers
Dialysis centers
Infusion Therapy
School Health Services
Retail Clinics
Emergency Dept.

Question 23

role of LPN in ambulatory health care

Answer 23

In Ambulatory care settings nurses have the opportunity to use many different skills learned.

In addition to routine client care, nurses in ambulatory settings perform many other duties not usually performed by nurses in acute-care setting.

LPN’s who work in ambulatory care centers provide direct assistance to Physicians or other types of Providers

Question 24

telephone triage is defined as

Answer 24

Defined as: an interactive process between the nurse and the patient that occurs over the phone and involves identifying the nature and urgency of client healthcare needs and determines the appropriate disposition (rutenberg & Greenberg, 2012)

Question 25

the focus of telephone triage

Answer 25

Telephone triage is focused on the assessment and disposition of symptom based calls rather than message taking. Typically performed by the Nurse. Recognized and supported by most state boards. It does not involve making a diagnosis Nursing or Medical

Question 26

Interview to establish “Chief complaint”

Answer 26

``` Ask appropriate questions for the problem or symptoms Reason for today’s visit Onset of symptoms Description of the symptoms Duration Intensity Frequency History Accompanying signs and symptoms Precipitating/Alleviating factors Progression ```

Question 27

is telephone triage involve making a diagnosis

Answer 27

no

Question 28

Autoimmune diseases occur

Answer 28

when there is a breakdown of tolerance; immune system identifies its own proteins as foreign and mounts a response to destroy these self-proteins Examples: idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), acute rheumatic fever, type 1 diabetes mellitus, systemic lupus erythematosus, rheumatoid arthritis, Graves’ disease, and Hashimoto’s thyroiditis

Question 29

are mediated by IgE reacting to common allergens, such as dust, pollen, animal dander, insect stings, or various drugs

Answer 29

Type 1

Question 30

are mediated by antibody reactions | Can occur with a mismatched blood transfusion or as response to various drugs

Answer 30

Type 2

Question 31

result in tissue damage resulting from precipitation of antigen-antibody immune complexes Can occur with autoimmune reactions,

Answer 31

type 3

Question 32

Delayed hypersensitivity reactions result from immune cells migrating to the site of exposure days after the exposure to the antigen Can occur with contact dermatitis, measles rash, tuberculin skin testing, or various drugs

Answer 32

type 4

Question 33

Inflammatory response

Answer 33

redness, heat, swelling

Question 34

Autoimmune disease: immune system unable to recognize itself; mounts an immune response against its own proteins Damage from antibodies and immune complexes directed against one/many organs

Answer 34

Lupus

Question 35

S/s of lupus

Answer 35

Fatigue, malaise, fever, anorexia, nausea, and weight loss Arthralgias and myalgias Joints often swollen, tender, stiff, and painful Rash and photosensitivity Butterfly-shaped rash across the bridge of the nose and the cheeks Inflammation of the retina can result in sudden-onset blindness

Question 36

medical treatment for lupus

Answer 36

Analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarials, corticosteroids Cytotoxic agents suppress the abnormal immune response

Question 37

ways to admister chemotherapy

Answer 37

oral, intramuscular, intravenous, intracavity, intrathecal

Question 38

A healthy response | May be associated with grieving before a death actually occurs or when the reality that death is inevitable is known

Answer 38

adaptive grief

Question 39

Usually related to a loss or death May be a healthy or an unhealthy response to the grief process Patient and family members can experience anticipatory grieving

Answer 39

anticipatory grief

Question 40

After an actual loss or a death occurs

Answer 40

reactive grief

Question 41

Grief that is delayed or exaggerated May relate to a real loss or a perceived loss May occur in the absence of anticipatory grief,

Answer 41

dysfunctional grief

Question 42

sensory changes

Answer 42

Include decreasing pain and touch perception, blurred vision, and decreasing sense of taste and smell Blink reflex lost eventually; patient appears to stare The sense of touch decreases first in the lower extremities in response to circulatory changes Hearing is commonly believed to be the last sense to remain intact during the death process Assume that the patient can hear and understand Body gradually relaxes until all function ends Generally, respirations cease first The heart stops beating within a few minutes The physician is responsible for ordering discontinuation of life support if it is in use Physician also responsible for pronouncement of death in most situations

Question 43

Type 1 diabetes

Answer 43

Absence of endogenous insulin Formerly called juvenile-onset diabetes because it most commonly occurs in juveniles and young adults An autoimmune process, possibly triggered by a viral infection, destroys beta cells, the development of insulin antibodies, and the production of islet cell antibodies (ICAs) Affected people require exogenous insulin for the rest of their lives

Question 44

Type 2 Diabetes

Answer 44

Inadequate endogenous insulin and body’s inability to properly use insulin Beta cells respond inadequately to hyperglycemia; results in chronically elevated blood glucose Continuous high glucose level in the blood desensitizes the beta cells; they become less responsive to the elevated glucose More common in adults; increasing in children Controlled by diet and exercise; may require oral hypoglycemic agents or exogenous insulin

Question 45

role of insulin

Answer 45

Insulin stimulates active transport of glucose into cells Promotes fatty acid synthesis and conversion of fatty acids into fat, which is stored as adipose tissue Enhances protein synthesis in tissues and inhibits the conversion of protein into glucose

Question 46

risk factors for diabetes

Answer 46

obesity hx if gestational diabetes sedentary lifestyle metabolic syndrome

Question 47

type 1 is an what?

Answer 47

autoimmune disease

Question 48

long term complications of diabetes

Answer 48

retrinopathy neuropathy nephropathy= kidney damages

Question 49

all pt with type 1 need

Answer 49

insulin injection | type 2 will eventually some

Question 50

how are insulin given

Answer 50

all insulins can be given sub q | only regular insulin can be given IV

Question 51

premixed insulin's contain

Answer 51

Contain both Regular and NPH insulin | regular first and N second for mxing

Question 52

indications of diabetes

Answer 52

One or more of the following criteria on two separate occasions is considered DM Polyuria, polydipsia, polyphagia, unexplained weight loss plus random glucose level >200 mg/dL Fasting serum glucose level >126 mg/dL (after at least an 8-hour fast) Two-hour postprandial glucose level >200 mg/dL during oral glucose tolerance test (OGTT) under specific guidelines. Test must use a glucose load of 75 g of anhydrous glucose dissolved in water

Question 53

Hypoglycemia s/s

Answer 53

glucose levels falls 45-50 shakiness, nervousness, irritability, tachycardia, anxiety, lightheadedness, headache, hunger, tingling or numbness of the lips or tongue, and diaphoresis When treatment is delayed or Bg falls over several hours: drowsiness, irritability, impaired judgment, blurred or double vision, slurred speech, headaches, and mood swings progressing to disorientation, seizures, and in severe cases unconsciousness leading to coma

Question 54

treatment of hypolycemia

Answer 54

Give patient 10 to 15 g of quick-acting carbohydrates (e.g.1/2 cup milk or orange juice). Repeat every 15-30 minutes until blood glucose is >70 mg/dL for adults, 80 to 100 mg/dL for older adults and children If patient is unable to swallow, an IM or subcutaneous injection of 1 mg of glucagon or an IV dose of 50 mL of 50% d

Question 55

structures in the pituatory include

Answer 55

``` Hypothalamus Pituitary gland Thyroid gland Parathyroid glands Adrenal glands Pancreas ```

Question 56

function of pancreas

Answer 56

``` An accessory gland for digestion Exocrine and endocrine functions Exocrine function: Secretes digestive enzymes (amylase, lipase, trypsin) Pancreas secretes enzymes into the duodenum through the pancreatic duct Endocrine function: Secretes hormones (insulin, glucagon, somatostatin) from the islets of Langerhans Endocrine glands discharge secretions into the blood & lymph ```

Question 57

Pathologic state caused by excess production of one or more of the anterior pituitary hormones (gigantism) Common factor is presence of a pituitary adenoma Growth hormone and/or prolactin often in excess Overproduction GH (before puberty) leads to gigantism which is less common than acromegaly (after puberty) Overproduction of prolactin causes prolactemia

Answer 57

hyperpituitarism

Question 58

acromegaly

Answer 58

Bone thickening with transverse growth & tissue enlargement Face & hands most affected Visual defects r/t pressure from pituitary tumor on optic nerve, soft tissue swelling, or hypertrophy of face Cartilage overgrowth Organs can enlarge Treatment r/t cause (hyperplasia or tumor) Irradiation of Pituitary Gland Surgical removal of tumor (transfrontal or transsphenoid approach)

Question 59

Excessive output of dilute urine Antidiuretic hormone deficiency or inability of kidneys to respond to ADH results in the excretion of large volumes of very dilute urine

Answer 59

Diabetes insibitus

Question 60

s/s diabetes insibitus

Answer 60

Massive diuresis, dehydration, and thirst | Malaise, lethargy, and irritability

Question 61

Production of excess amounts of corticosteroids, particularly glucocorticoid Overproduction: endogenous (internal) as well as exogenous (external)

Answer 61

cushings disease

Question 62

s/s of cushings disease

Answer 62

Truncal obesity Protein wasting Facial fullness, often called a “moon face” Purple striae on the abdomen, breasts, buttocks, or thighs Osteoporosis Hypokalemia of uncertain etiology Produces marked changes in personal appearance, including obesity, facial redness, hirsutism (growth of hair), menstrual disorders, hypertension of varying degrees, muscle wasting of extremities Additionally delayed wound healing, insomnia, irrational behavior, and mood disturbances such as irritability and anxiety