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NURS 6550 FINAL EXAM|2025

February 15, 2025/in Nursing Questions /by Besttutor

NURS 6550 FINAL EXAM / NURS6550 FINAL EXAM (3 VERSIONS) (100 CORRECT Q & A IN EACH VERSION, TOTAL: 300 Q & A)

NURS 6550 Final Exam / NURS6550 Final Exam (Latest): Walden University

Walden University NURS 6550 Final Exam / Walden University NURS6550 Final Exam

QUESTION 1

1. Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter was inserted intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid infusion. Today his morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading differential includes:

Foley lodged in the urethra causing post-renal failure

Decreased renal perfusion causing prerenal failure

Age-related decreased eGFR causing prerenal failure

Post-surgical rhabdomyolysis causing intrarenal failure

QUESTION 2

1. Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak, diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black female who is awake, alert, and oriented, anxious, with moist skin and racing pulse. Her blood pressure is 140/100 mm Hg. Temperature and respiratory rate are within normal limits. The patient admits to having a “thyroid condition” but she never followed up on it when she was advised to see an endocrinologist. The AGACNP anticipates a diagnosis of:

Hashimoto’s thyroiditis

Cushing’s syndrome

Grave’s disease

Addison’s disease

QUESTION 3

1. Systemic lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can prevent with a wide variety of manifestations. Which clinical triad should prompt an evaluation for SLE?

Fever, normal white count, elevated sedimentation rate

Hyperkalemia, hyponatremia, low blood pressure

Leukocytosis, hyperglycemia, hypokalemia

Joint pain, rash, fever

QUESTION 4

1. A patient presents with profound vertigo of acute onset yesterday. She can barely turn her head without becoming very vertiginous; she is nauseous and just doesn’t want to move. This morning when she tried to get out of bed she felt like she was pushed back down. The vertigo is reproducible with cervical rotation. The patient denies any hearing loss or tinnitus, she has no fever or other symptoms. The AGACNP knows that the most helpful intervention will probably be:

Meclizine

Diazepam

Bed rest

Epley’s maneuvers

QUESTION 5

1. Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental status change from the long term care facility. She is normally ambulatory and participates in lots of facility activities. Today a nursing assistant found her in her room, appearing confused and disconnected from her environment. When she tried to get up she fell down. Her vital signs are stable excepting a blood pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her symptoms is:

Osteoarthritis

Drug or alcohol toxicity

Hypotension

Urosepsis

QUESTION 6

1. A patient with SIADH would be expected to demonstrate which pattern of laboratory abnormalities?

Serum Na+ 119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality of 900 mOsm/kg

Serum Na+ 152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality of 300 mOsm/kg

Serum Na+ 121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality of 850 mOsm/kg

Serum Na+ 158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality of 420 mOsm/kg

QUESTION 7

1. Sean is a 29-year-old male who presents to the emergency department for evaluation and treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal is attempted unsuccessfully with a moist cotton tipped swab. A wet fluorescein stain is applied to the lower eyelid, and a corneal abrasion ruled out but the AGACNP notes a positive Seidel sign. This indicates:

Penetration of the cornea with resultant aqueous leak

A rust ring remnant due to metal foreign body

An elevated intraocular pressure

Paradoxical pupil dilation in response to light

QUESTION 8

1. Mrs. Lowen is an 82-year-old female who comes to the emergency department for evaluation of a fever of 102.9° F. She complains of a headache in the right side of her temple and some right-sided jaw pain. A urinalysis, chest radiograph, complete blood count (CBC) and 12-lead ECG are all non-contributory. A comprehensive metabolic panel is significant only for a slightly elevated BUN and creatinine. The AGACNP appreciates distinct right temple tenderness to percussion. Which laboratory test is necessary to support the suspected diagnosis?

An erythrocyte sedimentation rate

A white blood cell differential

Two sets of blood cultures

Echocardiography

QUESTION 9

1. Ms. Schiebel, a 31-year-old female who is brought to the emergency department by police after being arrested for disruptive behavior in a public establishment. The differential diagnosis includes drug and alcohol ingestion/toxicity, central nervous system disease, severe trauma, and psychotic illness; ultimately the alcohol and toxicology screen as well as head imaging are negative. When considering psychotic illness, the AGACP knows that this is a physiologic imbalance that typically involves an excess of:

Serotonin

Norepinephrine

Acetylcholine

Dopamine

QUESTION 10

1. Mr. Lincoln is a 55-year-old male who was admitted for management of sepsis secondary to pneumonia. He has declined rapidly, and today chest radiography demonstrates a diffuse, bilateral “white-out” appearance. His paO2 is 55 mm Hg. In order to increase his oxygenation the AGACNP knows that which of the following interventions is indicated?

Increased FiO2

Increased respiratory rate

Increased tidal volume

Increased PEEP

QUESTION 11

1. A 29-year-old female patient presents with a complaint of palpitations. Physical examination reveals an essentially healthy female with no significant medical history and no maintenance medications; the only thing she can report is that she had a head cold a week or so ago. The vital signs include a blood pressure of 139/90 mm Hg, pulse of 105 b.p.m, respiratory rate of 16 b.p.m. and a temperature of 98.6° F. The only abnormal finding on physical examination is diffuse anterior neck tenderness with thyroid palpation. The AGACNP considers which medication for symptom control?

Ibuprofen

Pseudoephedrine

Propranolol

Methimazole

QUESTION 12

1. Jennifer is an 18-year-old homeless female who was found unresponsive. She was admitted to the hospital for management of severe bleeding after a spontaneous abortion escalated to a uterine hemorrhage. An underlying infection and dehydration were corrected and nutritional supplements were started. Her volume status is stable, morning labs were all within normal limits and she is to be discharged today. When the AGACNP enters the room to prepare the patient for discharge, she finds her agitated, pale, and diaphoretic with vital signs to include a pulse of 105 bpm, respirations of 24 bpm, blood pressure of 110/76 mm Hg and a temperature is 97.9° F. The most appropriate action would be to:

Order a CBC to assess for recurrent bleeding

Request and abdominal CT to assess for bleeding

Evaluate the patient for anxiety/panic attack

Prescribe alprazolam 1 mg now

QUESTION 13

1. Physical examination findings in a patient with pneumothorax is likely to reveal:

Increased tactile fremitus

Low grade temperature

Hyperresonance to percussion

Egophany

QUESTION 14

1. Mr. Parker brings his 73-year-old wife to a clinic appointment because he is worried about her. She has a long history of hypertension and dyslipidemia, but he says she has taken medication for years and everything has been OK. His concern today is that for a long time she has been very forgetful, and he has tried to help her by keeping a strict routine around the house. Over the past few months, she just seems more and more forgetful, does not seem interested in doing anything, and now seems to be forgetting how to do simple everyday tasks. Yesterday she could not figure out which dollar bills to use at the store to pay the cashier. The AGACNP knows Mrs. Parker should first be screened for:

Depression

A brain tumor

Hypothyroidism

Adrenal dysfunction

QUESTION 15

1. M.R. is a 40-year-old female who has a known history of peptic ulcer disease. She has been admitted through the emergency room with a diagnosis of GI bleeding—she is vomiting dark blood and had a nasogastric tube placed. When attached to low intermittent suction it initially drained 400 cc of dark brown/black drainage, but now it is starting to drain lighter red colored blood. The AGACNP knows that immediate priorities of care include:

Ensuring hemodynamic stability

Beginning a parenteral proton pump inhibitor

Beginning gastric lavage

Ordering a gastrointestinal consult

QUESTION 16

1. A patient with sharp, stabbing chest pain directly over the precordium has a 12-lead ECG that demonstrates concave ST-T wave elevations in leads II, III, avR, avL, avF, and all six precordial leads. The AGACNP expects which physical finding?

A grade IV/VI systolic murmur with radiation to the axilla

A split S2 that increases with inspiration

A pericardial friction rub

An S4 heart sound

QUESTION 17

1. J.Q. is a 45-year-old male who had gastric bypass surgery 18 months ago. A CBC reveals a macrocytic anemia with aHgb of 9.8 g/dL, HCT of 30%, MCV of 115 and RDW of 19%. The AGACNP suspects which type of anemia?

Iron deficiency

Sickle cell anemia

Pernicious anemia

Anemia of chronic disease

QUESTION 18

1. Megan K. is a 21-year-old female who presents complaining of irritated eyes. She says this happens a couple of times a year and this time it is really a problem. Both eyes are itchy and red and she has a lot of stringy discharge, especially at the end of the day. Her visual acuity is 20/25 OS, OD, and OU with her glasses on. Physical exam reveals injected conjunctiva bilaterally but there is no photophobia. Pupils are equal, round, briskly reactive, and accommodate. The AGACNP knows that immediate treatment should include ophthalmic application of:

Steroids

Antihistamine

Antibiotic

Cycloplegic

QUESTION 19

1. Ellen is a 61-year-old female who presents with a chief complaint of neck pain. The history of present illness reveals that Ellen felt as though a bug bit her behind the neck a few days ago. A day or two later it started to hurt, and when she began to pick at it she felt drainage come out. She is here now for evaluation. Physical exam reveals an 8 cm x 8 cm draining abscess in the right post auricular region with posterior cervical lymphadenopathy. Ellen has a temperature today of 101.9° F. The AGACNP knows that in addition to incision and drainage of the abscess, effective management must include:

Systemic antibiotics

Tetanus immune globulin

Tetanus toxoid

Antipyretics

QUESTION 20

1. A 13-year-old male presents with a chief complaint of ear drainage. The patient and his mother both indicate that the patient has not had any pain or any systemic complaints, but the pus-like discharge from the ear is very persistent. According to Mom they went to a retail clinic two weeks ago and the patient was prescribed both oral antibiotics and ear drops, but it didn’t help. Physical exam of the ear reveals a painless pinna; otoscope exam reveals only a large amount of mucopurulent drainage—the tympanic membrane could not be visualized. The AGACNP knows the diagnosis is most likely:

Acute otitis media

Acute otitis externa

Cholesteatoma

Otitis media with effusion

QUESTION 21

1. A 71-year-old male patient with lung cancer is admitted for treatment of sepsis related to his chemotherapy-induced immunosuppression. He seems to be improving from an infectious perspective, but during today’s assessment the AGACNP appreciates coarse rales in the lung fields, a blood pressure of 140-100 mm Hg, a bounding pulse, and trace pretibial edema. The urine output via Foley catheter has only been 100 mL in the last 8 hours. Suspicious for syndrome of inappropriate antidiuretic hormone (SIADH), the AGACNP orders a basic metabolic panel anticipating which of the following abnormalities?

Hypokalemia

Hypocalcemia

Hyponatremia

Hypochloremia

QUESTION 22

1. A crescendo-decrescendo systolic murmur best appreciated at the second intercostal space, right sternal border with radiation to the carotid artery is most likely an indicator of:

Aortic stenosis

Aortic regurgitation

Tricuspid stenosis

Tricuspid regurgitation

QUESTION 23

1. The AGACNP knows that diagnostic findings consistent with rheumatoid arthritis include:

Soft tissue swelling of the metacarpals

Radiographic joint space narrowing

Heberden’s nodes

Subungal hemorrhages

QUESTION 24

1. C.T. is a 39-year-old female who presents for evaluation of what she thinks is her “rosacea acting up.” She has a history of acne rosacea and has medicated on and off for years with tetracycline and topical metronidazole. Today however she presents with a pronounced red/purple area on her left cheek extending to the nasal border. It is very warm to the touch. The borders of the affected area are very well defined and raised. C.T. also has a temperature of 100.7° F and a generalized headache. The AGACNP appreciates tender submandibular and cervical lymphadenopathy. The likely diagnosis is:

Complex rosacea

Cellulitis

Erysipelas

Allergic reaction

QUESTION 25

1. Mr. Lopez is a 51-year-old male patient who is being treated for T2DM. His HgbA1c is 15.6% and initial management will include aggressive attempts for weight reduction as his body mass index (BMI) is 45. He says he is unable to participate in any meaningful exercise because he very often has back pain; he has had it for years and has tried all sort of over the counter medicines with little relief. He describes it as a profound ache that occurs across the lower part of his back bilaterally; it does not travel down either leg. The physical inspection is normal, but he has significant paraspinal tenderness to palpation bilaterally. He cannot identify any injury or accident that preceded the pain. The history and physical exam is noncontributory. The AGACP knows that the likely diagnosis is:

Lumbar radiculopathy

Ankylosing spondylitis

Lumbar sacral strain

Degenerative disk disease

QUESTION 26

1. A patient presents with acute onset of vesicular lesions on her vulva. They are surrounded by areas of redness and they hurt. The patient says that she has even more of them now then she did when she woke up this morning. There is also inguinal lymphadenopathy. The AGACNP is suspicious for:

Human papilloma virus

Primary syphilis

Gonorrhea

Herpes simplex virus

QUESTION 27

1. Classic radiographic features of osteoarthritis include:

Soft tissue swelling

Joint deformity

Bone mineral loss

Joint space narrowing

QUESTION 28

1. Mrs. Sandoval is a 72-year-old female who presents with a chief complaint of transient verbal confusion. She was speaking with her friend on the phone this morning when she suddenly couldn’t get words out. Her friend went over to her home and found Mrs. Sandoval awake, alert, and oriented, responding appropriately with non-verbal gestures, but she could not properly articulate her thoughts. By the time she arrived at the office this had passed, although during the examination she appeared to have infrequent difficulty finding a single word. The patient denies any contributory medical history, but a 12-lead ECG in the office reveals atrial fibrillation with a ventricular response of 91 b.p.m. The blood pressure is 140/94 mm Hg; remaining vital signs are normal. The AGACNP knows that management should include:

Antiplatelet therapy

Anticoagulation

Blood pressure control

Speech therapy

QUESTION 29

1. C.L. is a 48-year-old female who presents complaining of activity intolerance. She is usually very active and fit^. She jogs regularly and typically does 4-5 miles a day. About a week ago she became so tired she had to stop, and lately she has become aware of becoming easily fatigued while going up and down stairs. She admits that she thinks she is beginning menopause—she is having a lot of bleeding with her periods, and her periods seem to be more frequent. A complete blood count (CBC) reveals the following results:
Hgb 10.1 g/dL
Hct 30%
MCV 75 fL
RDW 21%
The AGACNP orders which of the following laboratory test to confirm the suspected diagnosis?

Vitamin B12

Folate

Ferritin

Hemoglobin electrophoresis

QUESTION 30

1. Kevin H. is a 61-year-old male who presents for treatment of profound anxiety. He has been treated on and off for years—most recently he was taking escitalopram 20 mg p.o. daily, and although he does admit to some improvement, he still cannot function appropriately thoughout the day. He has been counseled about poor work performance and is concerned about losing his job, but he is just so worried all of the time he cannot concentrate on work. The AGACNP knows that the most appropriate action is to:

Increase the dose of escitalopram to 40 mg daily

Refer Kevin for a psychiatric consultation

Stop escitalopram and begin venlafaxine

Discuss therapeutic expectations with Kevin

QUESTION 31

1. When examining a patient with a skin presentation suggestive of necrotizing fasciitis, the AGACNP knows that the most important and sensitive diagnostic test is:

A complete blood count

Plain film radiographs

The finger test

CT scan

QUESTION 32

1. While evaluating a patient with abdominal pain, the AGACP knows that when the pain is described as coming in waves or cycles, with periods of relief in between, the cause likely centers around:

Peristalsis of bowel

Disorders of pelvic organs

Organ inflammation

Hyperacidity

QUESTION 33

1. Which of the following findings is not typically associated with testicular torsion?

Acute pain

Edema

High riding testis

Dysuria

QUESTION 34

1. 152: When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Yes

QUESTION 35

1. While preparing to perform an incision and drainage on a 7 cm fluctuant abscess on a patients posterior thorax, the AGACNP knows that the most important part of the procedure is:

Immediate coverage with antistaphylococcal antibiotics

Maintaining sterility with topical betadine and drapes

Breaking up loculations and aggressive irrigation

Proper injection of local anesthetic

QUESTION 36

1. A patient is being evaluated with significant nausea, fatigue, and a general sense of feeling unwell; mild jaundice is noted on physical examination. Transaminases are markedly elevated and a hepatitis screening is done. Results are as follows:

+ HbsAb

+ anti-HAV IgM

– anti-HCV

The correct interpretation of these findings is:

The patient has acute hepatitis A

The patient has acute hepatitis B

The patient has chronic hepatitis B

The patient has acute hepatitis C

QUESTION 37

1. When treating a patient with an unknown overdose or toxicity, the AGACNP knows that all of the following should be administered except:

Dextrose 50%

Thiamine 100 mg

Nalaxone 0.4 mg

Ativan 4 mg

QUESTION 38

1. The AGACNP is evaluating 29-year-old female who presents by ambulance and is unresponsive. There is no witness and no history available; the patient is not wearing any sort of medic alert bracelet. While assessing for toxicity or overdose, the patient is found to have vital signs as follows: Temp of 96.2° F, pulse of 48 b.p.m., respirations of 10 b.p.m., and blood pressure of 84/50 mm Hg. The patient’s pupils are constricted, but do react briskly to light to 1 mm. The AGACNP suspects which type of substance?

Cholinesterase inhibiting drugs

Stimulants such as MDMA

Anticholinergics

Ethanol or opiates

QUESTION 39

1. The AGACNP knows that the one class of pain medication that is effective to some extent for all forms of pain is:

NSAIDs

Antidepressants

Antiepileptics

Opiates

QUESTION 40

1. K.P. is a 76-year-old male admitted for antibiotic management of urosepsis. His medical history is significant for a CVA with resultant right-sided hemiparesis. He is nonverbal, maintained on enteral nutritional support and has an indwelling Foley catheter. The AGACNP knows that which of the following bacteria is the primary treatment target for this patient’s urosepsis?

Proteus mirabilis

Pseudomonas aeruginosa

Staphylococcus aureus

Streptococcus pneumoniae

QUESTION 41

1. A patient is admitted for a COPD exacerbation and placed on mechanical ventilation. His settings are as follows: FiO2 of 40%, TV of 700mL, SIMV of 12. His morning ABG reveals a pH of 7.37, paCO2 of 51 mm Hg, paO2 of 84 mm Hg and HCO3 of 30 mm Hg. The AGACNP knows that the appropriate response is to:

Leave the ventilator settings as is

Increase the SIMV to 16 b.p.m.

Increase the FiO2 to 50%

Repeat the ABG in one hour

QUESTION 42

1. All of the following are required for a diagnosis of systemic inflammatory response syndrome (SIRS) except:

White blood cell count < 4000 or > 12,000 cells/uL

Heart rate > 90 b.p.m.

Respiratory rate > 20 b.p.m. or paCO2 < 32 mm Hg

Two sets of positive blood cultures

QUESTION 43

1. J.T. is a 41-year-old female patient who presents with a chief complaint of “heartburn.” She says that it doesn’t really seem to be related to meals or food—it occurs at random times. She does note, when asked, that it seems to happen a lot at night and occasionally wakes her up. Her only other symptom complaint is an occasional cough. It does not produce mucus, and she admits to assuming it was a “nervous” cough. The next appropriate action for the AGACNP would be to:

Order an H. pylori test

Request a GI consult for endoscopy

Order a proton pump inhibitor 30 minutes before breakfast

Request a 72-hour diet history

QUESTION 44

1. Your patient has diabetes insipidus (DI). Anticipated physical assessment findings include:

Dry skin, tachycardia, hypertension

Weak pulse, dry skin, decreased skin turgor

Thin hair, thready pulse, dry mucous membranes

Hypothermia, jugular venous distention, bradycardia

QUESTION 45

1. The AGACNP is beginning medical management of a patient newly diagnosed with T2DM. The patient has a BMI of 39 and has been unsuccessful in making significant diet and lifestyle changes over the last six months. Other than her weight, her physical examination is essentially within normal limits. Her HgbA1c is 9.5%. A basic metabolic panel is within normal limits. The medication of choice to begin therapy will be:

A sulfonyurea

A meglitinide

A biguanide

An incretin mimetic

QUESTION 46

1. Felty’s syndrome is a condition of immune neutropenia seen sometimes in patients with:

Polymyalgia rheumatica

Giant cell arteritis

Systemic lupus erythematosus

Rheumatoid arthritis

QUESTION 47

1. When treating a patient for the profound cough of acute bronchitis, the AGACNP knows that the most appropriate pharmacotherapy consists of:

An opiate based cough suppressant

Oral prednisone

A first generation-antihistamine combination

An inhaled anticholinergic

QUESTION 48

1. Mr. Truman is transferred to the emergency department by ambulance. His wife called 911 this morning because he was acting “funny” when he woke up. Both the patient and his wife went to bed last night at approximately 10:30 and everything was normal. This morning he could not communicate orally and seemed confused about how to ambulate. Upon arrival to the emergency department his vital signs are as follows: Temperature 100.9° F, pulse 89 b.p.m., respirations 14 b.p.m. and blood pressure 168/94 mm Hg. A non-contrast CT scan of the head reveals thrombotic CVA. The AGACNP know that immediate management of this patient should include:

Thrombolytics

IV vasodilators

Aspirin

Antiepileptics

QUESTION 49

1. Your patient is complaining of profound nausea and vomiting that started at bedtime last night and kept him awake all night long. Early this morning he started having abdominal cramping and explosive diarrhea. Based upon the character of symptoms you are suspicious of infection with Staphylococcus aureus. To assess risk for exposure to this organism, you ask the patient about which meal?

Breakfast yesterday

Lunch yesterday

Dinner yesterday

Bedtime snack yesterday

QUESTION 50

1. D.R. is a 54-year-old male patient who was admitted for the management of cellulitis and treated with parenteral antibiotics. He has not been responding as well as anticipated. During today’s exam the AGACNP appreciates a couple of changes. All of the following indicate the need for immediate surgical evaluation except:

Skin anesthesia

Violaceous bullae

Gas bubbles in tissue

Lymphangetic spread

QUESTION 51

1. R. O. is a 21-year-old female who comes to the emergency department because of a severe headache. Her vital signs and neurological examination are within normal limits. She complains of a pulse-like pain in her right temple and admits that she has almost vomited. Her mother gets the same type of headache and the last time this happened R.O. took one of her mother’s prescription headache pills. They helped a lot, but this time her mother told her she had to come be evaluated. The AGACNP knows that which of the following is the appropriate action?

A non-contrast CT scan of the head

Administration of a 5HT agonist

Dilaudid 2 mg IM x 1 dose

Requesting a headache diary

QUESTION 52

1. A 39-year-old female presents for evaluation of a rash. She denies any significant medical history, and has no other complaints. The rash appeared suddenly on both forearms approximately one week ago, and she is concerned because it is not going away. It does not itch or hurt—it is just there. Physical examination reveals a diffuse macular hypopigmentation on both forearms that extends to the hands. The patient denies any drug or alcohol use; she is single and has had 4 unprotected sexual partners in the last year. The AGACNP knows that initial laboratory testing must include a(n):

FTA-Abs

Fungal skin scraping

RPR screening

CBC

QUESTION 53

1. J.S. is a African-American female who presents for a wellness examination. Her medical history is significant for beta thalassemia minor. Anticipated red blood cell differential would include which of the following patterns?

Hgb 10.2 g/dL, Hct 30%, MCV 70 fL, RDW 12.6%

Hgb 9.9 g/dL, Hct 28%, MCV 83 fL, RDW 13.9%

Hgb 11.5 g/dL, Hct 35%, MCV 94 fL, RDW 15.8%

Hgb 12.8 g/dL, Hct 38%, MCV 105 fL, RDW 18.1%

QUESTION 54

1. M.T. presents complaining of acute pain in his left eye, nausea, and one episode of vomiting. He denies any significant medical problems, and says that the only medication that he takes is an occasional over-the-counter sleeping pill. Physical examination reveals a steamy red cornea and conjunctiva with a pupil that is 5 mm and not reactive to light. The AGACNP knows that diagnostic testing should include:

A CT scan of the head

An MRI of the orbit

A toxicology screen

A measurement of intraocular pressure

QUESTION 55

1. Justin is a 23-year-old male who is being managed for an acute manic episode. Justin was diagnosed with bipolar disorder several years ago, but his home life has been unstable and he has not been very adherent to a medication regimen. Most recently he was started on the SNRI venlafaxine by his primary care provider, which he has been taking as prescribed for about 6 weeks, but he began a manic episode a few days ago which peaked this evening. The AGACNP considers that:

The manic episode is probably a result of medication instability and he should continue his current regimen with a follow-up in 6-8 weeks

A mood stabilizing agent should be added to the venlafaxine

All medication should be held for 6-8 weeks and the then the patient should be reevaluated

The SNRI should be stopped and a mood stabilizing agent started

QUESTION 56

1. Mr. Livingston is a 79-year-old male who presents from a long term care facility with a change in mental status. His medical history is significant for T2DM, CAD, CHF, hypothyroidism, Alzheimer’s dementia and osteoarthritis. He has been stable, but over the last few days the staff say he has been a bit disconnected. This morning he was found in his bed in a stuporous state. His vital signs include a temperture of 98.9° F, pulse of 103 b.p.m., respiratory rate of 20 b.p.m., and a blood pressure of 92/64 mm Hg. His metabolic panel demonstrates a Na+ of 129 mEq/L, K+ of 3.3 mEq/L, Cl- of 100 mEq/L, CO2 of 24 mEq/L, glucose of 644 mg/dL, BUN of 51 mg/dL and creatinine of 1.9 mg/dL. The AGACNP knows that the primary problem is most likely:

Diabetic ketoacidosis

Hypertonic hyponatremia

Myxedema coma

Hyperosmolar hyperglycemic coma

QUESTION 57

1. The AGACNP is evaluating a patient with systemic lupus erythematosis who complains of fatigue. Based upon his knowledge of the most commonly affected visceral organ, which of the following diagnostic studies should be ordered?

Echocardiogram

Chest radiography

Hepatic function enzymes

Urinalysis with microscopic

QUESTION 58

1. All of the following are true statements about post-traumatic stress disorders (PTSD) except:

It is more common in women than men

It is unlikely to occur in children especially < 10 years old

It is differentiated from acute stress reaction by time

It is not likely in persons with no preexisting psychiatric disease

QUESTION 59

1. Ray M., a 49-year-old male, walks into the emergency room complaining of back pain. He has never had this problem before and cannot identify any injury, but he is in such severe pain he is sure something is wrong. He states that his back has been hurting so badly sometimes he has to stop whatever he is doing and bend forward at the waist. The pain also travels along the outer edge of his left thigh to mid-calf, and he reports a small area of numbness on his anterior thigh. His history and physical examination are otherwise negative. He is an insurance attorney and is not especially active at work, but goes to the gym 5 days a week. He is not overweight, and his vital signs are normal. Physical examination reveals no paraspinal tenderness, and his straight leg raise is negative. A few times during the exam he lay back on the table and grabbed his left leg, flexed both hip, and pulled his knee to his chest, because it helped the pain. The AGACNP knows that immediate pain relief measures must include:

An opiate analgesic

Systemic steroids

Physical therapy

Bedrest for 72 hours

QUESTION 60

1. A patient with peptic ulcer disease is admitted to the hospital with significant upper abdominal discomfort. She has guarding and rebound tenderness on examination. Abdominal radiography demonstrates free air in the abdomen. The AGACNP knows that the immediate priority is to:

Obtain a stat surgical consult

Begin an IV proton pump inhibitor

Order an abdominal CT scan

Obtain a stat gastroenterology consult

QUESTION 61

1. Jennifer is a 15-year-old female who attempted suicide by taking a bottle of acetaminophen. She took 30, 500 mg tablets approximately six hours ago, but then became frightened and told her mother what she did. Her mother said that Jennifer seems OK, other than being a little sick to her stomach, she has no complaints. The AGACNP knows that the first step in her care includes:

N-acetycysteine in tapering doses over the next 24 hours

Oral administration of activated charcoal

Psychiatric assessment

Discharge to home with follow-up LFTs in 4 days

QUESTION 62

1. Mrs. Glassman is a 55-year-old female who presents with a chief complaint of fever. Her vital signs reveal a temperature of 100.0° F, blood pressure of 100/60 mm Hg, pulse of 114 b.p.m. and respirations of 20 b.p.m. Her cardiac auscultation reveals a grade III/VI systolic murmur at the left lower sternal border. Her history is significant for an eyebrow lift 4 months ago. The AGACNP orders which test to confirm the suspected diagnosis?

Three sets of blood cultures

A chest radiograph

A 12-lead ECG

Induced sputum culture

QUESTION 63

1. John is a 17-year-old male who is in the emergency department with abdominal pain. He is quite uncomfortable and says that it started yesterday and seemed to be “in the middle of his stomach” but today it has moved over to the right lower side. During physical examination the abdomen is not distended, but he is guarded, and right lower quadrant palpation produces significant discomfort, especially upon release of the palpating hand. He has appreciable pain when his right knee and hip are bent to a 90° angle. John admits to some nausea but has not vomited; he has not had a normal bowel movement in two days. His vital signs are as follows: Temperature 100.9° F, pulse 110 b.p.m. respiratory rate 22 b.p.m., and blood pressure 118/77 mm Hg. The AGACNP orders which of the following tests to confirm the suspected diagnosis?

Complete blood count

Ultrasound

CT scan

Urinalysis

QUESTION 64

1. Which of the following signs is expected in patients with cholecystitis?

McBurney’s

Cullen’s

Spurling’s

Murphy’s

QUESTION 65

1. According to the World Health Organization’s step-wise approach to pain management, initial approaches to step 2 might include all of the following except:

A weak opiate

A strong opiate

A non-steroidal antiinflammatory agent

An antidepressant.

QUESTION 66

1. A patient’s Weber test lateralizes to the right ear and the Rinne test in both ears is normal. The patient has a:

Sensorineural hearing loss in the left ear

Sensorineural hearing loss in the right ear

Conductive hearing loss in the left ear

Conductive hearing loss in the right ear

QUESTION 67

1. J.B. is a 62-year-old male who was admitted three days ago for management of diverticulitis. Today the AGACNP is called to the bedside to evaluate new onset swelling of the right lower extremity. According to the staff nurse it was not present yesterday but on today’s assessment the patient had 2A+ edema up to the thigh. Initial diagnostic evaluation should include:

Homan’s sign

A venogram

A D-dimer

CT of the chest

QUESTION 68

1. Based upon clinical examination and laboratory assessment the AGACNP diagnoses a patient with giant cell arteritis. The next step in the patient management should be to:

Consult surgery for a temporal artery biopsy

Consult rheumatology for medical management

Order 60 mg of prednisone now and q.d.

Order ceftriaxone 1 mg IV now

QUESTION 69

1. According to the JNC VIII criteria, a patient with a new diagnosis of hypertension who has comorbid chronic kidney disease should be started on which of the following classes of medications?

A thiazide diuretic

A calcium channel blocker

An ACE inhibitor

A beta adrenergic antagonist

QUESTION 70

1. Denise is a 45-year-old female who presents with significant lower abdominal pain. It started a few days ago and has just gotten steadily worse. She denies any hematuria or dysuria, but when she voids she feels like “everything is coming out. A physical examination reveals an abdomen that is tender to palpation but there is no guarding or rebound. Her vital signs are stable excepting a temperature of 100.9° F. The next step in the evaluation must include:

A complete blood count

An abdominal flat plate

A pelvic examination

A CT scan of the abdomen

QUESTION 71

1. Jan is a 39-year-old female who presents with significant right upper quadrant pain of 18 hours duration. She admits to a few episodes of vomiting. She right upper quadrant pain to palpation but the ultrasound is negative. Jan admits that this has happened before, usually when she “eats a huge meal.” The AGACNP orders which diagnostic study to confirm the diagnosis of cholecystitis?

Upright abdominal radiography

Hepatic function panel

HIDA scan

Abdominal CT

QUESTION 72

1. L.W. is a 41-year-old woman with a history of systemic lupus erythematosus which has been managed primarily with symptom control. Today she presents for evaluation of fatigue which has been slowly progressive over the last few months. She has a history of gastric bypass surgery 10 years ago and has maintained a 100 lb weight loss, but she maintains that she has been very adherent to her vitamin and mineral replacement regimen. Other than chronically heavy menses, for which she takes hormonal contraception, she is without complaint. A complete blood count is as follows:
Hgb 10.3 g/dL
Hct 31%
MCV 88 fL
RDW 15%
The AGACNP suspects that the patient’s fatigue is most likely due to:

Iron deficiency anemia

Anemia of chronic disease

Pernicious anemia

Folic acid deficiency

QUESTION 73

1. A patient presents for follow up after being started on an ACE inhibitor for hypertension. Her blood pressure has improved, but her pulse is 56 b.p.m down from 76 b.p.m. at her last visit. The AGACNP knows that the patient should assessed for:

Hypercalcemia

Hypernatremia

Hyperkalemia

Hyperchloremia

QUESTION 74

1. A young-adult male patient was dropped off outside of the emergency department and some staff members brought him inside. The patient is restless, irritable, and either unwilling or unable to participate in her own care. No history is available. His vital signs are essentially stable, finger stick blood sugar is 111 mg/dL, there are no signs of trauma, and no physical findings consistent with common drug or alcohol use. A toxicology screen is pending. The AGACNP orders acute psychiatric stabilization with a combination of haloperidol and lorazepam and considers which of the following mediations to decrease the risk of adverse effects?

Risperidone

Olanzapine

Benztropine

Zolpidem

QUESTION 75

1. Amy is a 21-year-old female who presents with acute nephrolithiasis. CT scan reveals a 2 mm stone in the left ureter. The AGACNP knows that the appropriate course of action is:

Pain control and IV fluid

Consultation for stent placement

Lithotripsy stone destruction

Transurethral stone destruction

QUESTION 76

1. B.T. is a 49-year-old male being admitted for lung volume reduction surgery. His preoperative pulmonary function tests are as follows:

FVC 66% predicted

FEV1 60% predicted

PEFR 69% predicted

TLC 104% predicted

RV 90% predicted

The AGACNP knows that the pulmonary function studies are consistent with:

Mild restrictive disease

Moderate restrictive disease

Mild obstructive disease

Moderate obstructive disease

QUESTION 77

1. A 30-year-old male patient presents for evaluation of a lump on his neck. He denies pain, itch, erythema, edema, or any other symptoms. He is concerned because it won’t go away. He says, “I noticed it a few months ago, then it seemed to disappear, and now it is back.” The AGACNP proceeds with a history and physical exam and concludes which of the following as the leading differential diagnosis?

Subclinical infection

Non-Hodgkin’s lymphoma

Catscratch disease

Syphilis

QUESTION 78

1. Ms. Teller presents with a chief complaint of weight loss. She reports an unplanned 10 lb weight loss over the last 5-6 months. She has no significant medical history, but review of systems reveals bilateral shoulder discomfort and some impaired range of motion—she has trouble pulling clothing over her head. Over the last few months she has generalized upper body stiffness, but seems to get better after an hour or so of activity. When considering a diagnosis of polymyalgia rheumatica, laboratory assessment may be expected to reveal:

An erythrocyte sedimentation rate (ESR) of 75 mm/hr

A microcytic, hypochromic anemia

Elevated liver function enzymes

Positive antinuclear antibodies

QUESTION 79

1. When a patient has lower abdominal discomfort, cervical wall motion tenderness, and adnexal tenderness, the AGACNP knows that this will likely be treated with:

Ceftriaxone and azithromycin

Metronidazole and ciprofloxacin

Trimethoprim/sulfamethoxazole

IV fluid and pain control

QUESTION 80

1. J.L. is an 81-year-old female who is admitted from home after her daughter found her confused and unkempt. She is not a good historian, and her daughter cannot provide any information—when she saw her mother a week ago, she was fine. J.L.’s vital signs are as follows: Temperature 101.4° F, pulse 99 b.p.m., respirations 22 b.p.m., and blood pressure 90/58 mm Hg. Her urinalysis is shows +++ leukocytes, + RBC, and + nitrites. Her metabolic panel reveals a BUN of 39 mg/dL and creatinine of 1.5 mg/dL. The AGACNP knows that J.L has findings consistent with:

Pre-renal failure

Intra-renal failure

Post-renal failure

Chronic renal failure

QUESTION 81

1. Patients with giant cell arteritis are at increased risk of:

Cerebrovascular accident

Rheumatoid arthritis

Polymyalgia rheumatica

Osteoarthritis

QUESTION 82

1. The AGACNP is called to the bedside for a patient who is in cardiopulmonary arrest. The monitor demonstrates ventricular fibrillation which will not convert despite several attempts to defibrillate at maximal voltage. While being briefed by the staff nurse on the patient medical history, he learns that the patient has a history of Cushing’s syndrome. The AGACNP recognizes that the patient is probably failing to convert due to:

Advanced atherosclerotic disease

Hypokalemia

Hypocalcemia

Catecholamine excess

QUESTION 83

1. When performing an evaluation of a patient following seizure activity, the AGACNP knows that the most important component of that evaluation is:

A CT scan of the head

Eyewitness description

An EEG

Administering a benzodiazepine

QUESTION 84

1. Which of the following etiologic organisms is most likely to appear as lobar consolidation on chest radiography?

Legionella pneumophilia

Streptococcus pneumoniae

Pneumocystis carinii

Mycoplasma pneumoniae

QUESTION 85

1. A patient with chronic kidney disease presents with an eGFR of 30 mL/min/1.73m2. The AGACNP knows that the most compelling implication of this value is:

Control of risk factors for renal deterioration

Careful attention to renal dosing of medications

Referring the patient for shunt placement

Preventing occurrence of renal ischemia

QUESTION 86

1. Differential diagnosis of hematuria include all of the following except:

Bladder cancer

Nephrolithiasis in the renal parenchyma

Urinary tract infection

Prerenal azotemia

QUESTION 87

1. A 29-year-old male patient presents with acute scrotal pain and dysuria. He has a temperature of 101.8° F and a pulse of 115 b.p.m. but otherwise vital signs are within normal limits. He gets some relief of the scrotal discomfort when his scrotum is elevated on a rolled towel. This is known as:

Varicocele

Prehn’s sign

Cremasteric sign

Testicular torsion

QUESTION 88

1. The AGACNP knows that patients with psoriasis are at greater risk for:

Arthritis

Eczema

Cellulitis

Melanoma

QUESTION 89

1. Mr. McCarran is a 68-year-old male with a long history of poorly controlled T2DM. He has had progressive burning pain in both feet for the last year or so, but in the last few months it has become increasingly worse. He has tried taking ibuprofen and naproxyn over-the-counter with no improvement. Now, he is presenting for more effective pain management. The AGACNP knows that the medication of choice will be from which drug class?

NSAIDs

Opiates

Antiepileptics

Anesthetics

QUESTION 90

1. Mr. Starwood is a 61-year-old male who was admitted last night for the management of acute pancreatitis. He was admitted n.p.o and started on intravenous fluid and opiate pain management. This morning he reports feeling significantly better. His C-reactive protein this a.m. is 5 mg/dL, amylase and lipase are both just over 2 x upper limits of normal, and his Ransom score is 2. The AGACNP knows that the next step in his care is to:

Begin clear liquids as tolerated

Order an abdominal CT

Order an ERCP

Continue the current management for 24 hours

QUESTION 91

1. When beginning pharmacotherapy for depression, the AGACNP discusses with the patient that a primary safety consideration includes the:

Increased risk of suicide when patients begin antidepressant therapy

Potential for sexual adverse effects

Better likelihood of success when medications and therapy are used together

High incidence of serotonin syndrome

QUESTION 92

1. When ruling out meningitis in a patient, the AGACP appreciates that the spinal fluid is cloudy and the glucose content is 20 cells/microliter. This is most consistent with:

Aseptic meningitis

Septic meningitis

Chemical meningitis

Chronic meningitis

QUESTION 93

1. A 44-year-old male patient presents in a hypertensive crisis. The blood pressure is 240/136 mm Hg, pulse is 128 b.p.m. and the patient is complaining of a severe, pounding headache. His skin is diaphoretic and he is visibly tremulous. The first diagnostic study to evaluate the suspected diagnosis should be a:

24 hour urine for catecholamine metabolites

Serum epinephrine and metanephrines

T scan of the abdomen

MRI of the abdomen

QUESTION 94

1. An unidentified patient is brought to the emergency department by ambulance after being hit by a motor vehicle. She has multiple injuries and an estimated blood loss of 2 liters. The hematocrit is 19%. The AGACNP expects that the mean cell volume (MCV) would most likely be:

70 fL

80 fL

90 fL

110 fL

QUESTION 95

1. Mrs. Oliver is a 71-year-old petite Caucasian female. During a routine dexa screening she was found to have a T-score of -3.0. The AGACNP knows that the first intervention should include:

Calcium

Vitamin D

Bisphosphonates

Estrogen

QUESTION 96

1. When evaluating a family with suspected carbon monoxide exposure, the AGACNP knows that assessment should include all of the following except:

Vital signs

Pulse oximetry

Cardiac rhythm strip

Carboxyhemoglobin level

QUESTION 97

1. Mr. Riley is a 61-year-old male who just had bilateral knee replacements. There was more fluid loss than intended during the procedure. The AGACNP knows that metabolic alkalosis is the most common postoperative acid-base imbalance and is best treated with:

Normal saline infusion

An insulin drip

Low volume hydrochloric acid

Albumin

QUESTION 98

1. Patients in advanced stages of chronic kidney disease are at greatest risk for which of the following conditions?

Polycythemia

Hypokalemia

Metabolic alkalosis

Anemia

QUESTION 99

1. The diagnostic study of choice in mesenteric ischemia is:

Ultrasound

CT angiography

MR angiography

Diagnostic peritoneal lavage

QUESTION 100

1. Mr. Maxwell is a 58-year-old male who presents with left foot pain. Physical examination reveals a foot that is normal in appearance with DP and PT pulses that are barely audible by Doppler. The AGACNP has the patient cross the leg with the left foot resting on the right knee; after 30 seconds that left foot is briskly lowered to the floor. Instantly the left foot turns bright red. This is known as:

Venous insufficiency

Brawny hyperpigmentation

Homan’s sign

Dependent rubor

QUESTION 101

1. 152: When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Yes

NURS 6550 Final Exam / NURS6550 Final Exam (Latest): Walden University

Walden University NURS 6550 Final Exam / Walden University NURS6550 Final Exam

Question

A 21-year-old woman requests hormonal emergency contraception after a condom break during intercourse approximately 16 hours ago. Today is day 14 of her normally 27–29 day menstrual cycle. You advise her that:

Likelihood of conception is minimal and emergency contraception use is not advised

Hormonal emergency contraception can be effective up to 5 days after intercourse

When taken as advised, hormonal emergency contraception use reduces the risk of pregnancy by up to 65%

The most likely mechanism of action of hormonal emergency contraceptive is as an abortifacient

Question

A 36-year-old man is hospitalized for alcohol poisoning. During follow-up evaluation the next day, he denies that he has a drinking problem. The best approach to assess for possible alcoholism is conducting which of the following questionnaires?

BDI.

HEADDS.

CAGE.

PHQ-9.

Question

A quality improvement plan characterized by limiting variability and removing defects in a process best describes:

Six Sigma.

Continuous Quality Improvement.

Total Quality Management.

Healthcare Stewardship.

Question

A 38-year-old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports earlier in the day she was feeling a migraine starting so she took a pill given to her by her friend who also experiences migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did she most likely take?

Acetaminophen and caffeine (Excedrin ® Migraine)

Naproxen sodium (Aleve ® )

Almotriptan (Axert ® )

Butalbital, acetaminophen and caffeine (Fioricet ® )

Question

All of the following are elements of malpractice except:

A duty of care to the patient.

A fee is charged for the healthcare services related to the malpractice claim.

Breach of the standard of care.

Injury.

Question

You are seeing a 68-year-old woman for treatment of an uncomplicated urinary tract infection (UTI). She has well-controlled hypertension, type 2 diabetes mellitus, and dyslipidemia and takes an angiotensin-converting enzyme inhibitor (ACEI), statin, biguanide, and low-dose aspirin (ASA). She worked in a dry cleaning facility until approximately 8 years ago. During her evaluation, she mentions that she sometimes has difficulty understanding conversation, especially in noisy environments. This is likely a:

Drug-related reaction.

Consequence of occupational chemical exposure.

Early sign of dementia.

Normal age-related change in hearing

Question

While evaluating a 33-year-old female with a 2-day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection (UTI) caused by a Gram-negative organism?

Nitrites

30 mg/dL protein

Epithelial cells

pH>8

Question

All of the following are examples of primary prevention strategies except:

Counseling an elderly patient prior to discharge about fall risk at home and how to prevent falls through adequate illumination.

Performing a hemoglobin A1C for all patients admitted to the hospital.

Conducting a study to identify the leading cause of mortality in teenagers and how to reduce risk.

Immunizing all adults ≥60 years with zoster vaccine.

Question

A 23-year-old woman is being evaluated for an upper respiratory tract infection. As you prepare for auscultation, the patient states “I have a benign murmur that has been with me my whole life”. Anticipating a physiologic murmur, you would expect which of the following characteristics?

Usually obliterates S2.

Becomes softer when going from a supine to standing position.

Occurs late in systole.

Has localized area of auscultation

Question

When evaluating the value of a test, the proportion of negative results that are truly negative best describes:

Positive predictive value.

Negative predictive value.

Sensitivity.

Specificity.

Question

A 16-year-old male presents for evaluation after a syncopal episode at school. He reports that he has recently been experiencing bouts of lightheadedness. His blood pressure is 126/76 mm Hg and his BMI=33 kg/m 2 . You notice velvet-like plaques at the nape of the neck. Laboratory assessment should include which of the following tests?

Hemoglobin A1c

Serum electrolytes

ALT/AST

Hemogram

Question

The NP is called to treat a 43-year-old woman for multiple contusions following a domestic violence attack. The NP realizes that one of the best predictors of a subsequent homicide of victims of domestic violence is:

History of alcohol/drug abuse by perpetrator.

Access to kitchen knives by the perpetrator.

History of perpetrator attempting to strangle the victim.

Issuance of a restraining order by the victim.

Question

A 48-year-old woman is being evaluated with chief complaints of fatigue, weakness, lethargy, and decreased concentration. She also mentions a notable increase in facial hair over the past 6 months as well as unexplained weight gain (about 25 lbs [11.3 kg]) over the past 2 months. Her past medical history is notable for moderate persistent asthma with multiple exacerbations over the past 8 months requiring treatment with prednisone. The most likely diagnosis is:

Type 2 diabetes mellitus.

Hashimoto thyroiditis.

Cushing’s syndrome.

Addison’s disease.

Question

You see a 73-year-old woman with a 40 pack-year smoking history, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) who presents with an ulcer on the sole of her left foot. The ulcer has an irregular edge and pale base and a punched out appearance, with the surrounding skin white and shiny. The patient states that the pain is worse at night in bed and when the legs are elevated. The most likely diagnosis is:

Pressure ulcer

Pyoderma gangrenosum

Venous ulcer

Arterial ulcer

Question

In evaluating a 62-year-old male with ischemic heart disease and mitral incompetency, you expect to find the murmur that is:

Localized systolic.

Diastolic with radiation to the neck.

Diastolic with little radiation.

Systolic with radiation to the axillae.

Question

21-year-old camp counselor presents for evaluation with a chief complaint of generalized itchiness. He has just returned after a week of summer camp. Physical examination reveals excoriated papules along his axillary folds and at the belt line. The NP suspects scabies and prescribes permethrin (Elimite ® ) lotion. In counseling the patient on the use of permethrin, the NP mentions that:

Its use is associated with neurotoxicity risk.

Itch often persists for a few weeks after successful treatment.

A marked reduction in lesions is noted within 48 hours.

The medication should be rinsed off within 2 hours of application.

Question

You see a 76-year-old woman living at home who is accompanied by her home care provider. She has COPD and type 2 diabetes mellitus. An example of a secondary prevention strategy is:

Administering the seasonal influenza vaccine.

Screening for physical or financial abuse/Checking her blood glucose level.

Checking her blood pressure.

Adjusting her insulin dosing regimen.

Question

A 43-year-old woman is being evaluated in the emergency department with a complaint of a severe headache. She describes a unilateral, pulsing headache that was preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm. The patient stated she noticed a “funny smell” prior to the symptoms starting. This description is most typical of:

Migraine with aura.

Cluster headache.

Transient ischemic attack.

Tension-type headache.

Question

A 20-year-old college student living in a campus dormitory has been diagnosed with meningococcal meningitis. The NP decides to speak with the university health officials and inform them that:

There is little to no risk of spread of the disease to other individuals.

Only intimate partners are at risk for infection.

Individuals with household-type or more intimate contact are at risk for infection.

All individuals on campus can be considered to be at risk for infection.

Question

You see a 54-year-old man living in subsidized housing with a history of hypertension. He states that he stopped taking his blood pressure medication about 4 months ago because of costs. He is concerned because his blood pressure is high whenever he checks it, though he does not report any symptoms. His BP at this visit is 196/104 mm Hg. Upon examination of this patient, you would expect to detect an S 4 sound heard during:

Early systole.

Late systole.

Early diastole.

Late diastole.

Question

32-year-old man requires evaluation for hepatitis infection prior to taking a job as a restaurant cook. He presents with the following laboratory results:

Hepatitis A Panel Hepatitis B Panel Hepatitis C Panel Anti-HAV Negative HBsAg Negative Anti-HCV Positive IgM Negative Anti-HBc Negative HCV RNA Negative IgM Negative Anti-HBs Positive You recognize the patient is susceptible to:

Hepatitis A and B

Hepatitis B and C

Hepatitis B only

Hepatitis A only

Question

When evaluating illness symptoms in older patients, the disease will often present differently from younger adults due to:

The likelihood of polypharmacy.

Decreased compensatory mechanisms in the elderly.

An increased physiologic response to illness in the elderly.

Presence of comorbid conditions.

Question

When prioritizing risk factors for bacterial endocarditis, the nurse practitioner knows who among the following patients has the highest risk.

A 55-year-old man with 3-vessel coronary artery bypass grafts with stents.

A 23-year-old woman with mitral valve prolapse without tissue redundancy.

A 65-year-old man with nonobstructive cardiomyopathy.

A 75-year-old woman with a nonorganic prosthetic aortic valve.

Question

The legal authority for NPs to perform healthcare services as defined by state law is called:

Duty of care.

Non-malfeasance.

Autonomy.

Scope of practice.

Question

A patient who was seen for an upper respiratory tract infection has an abnormal blood test result and requires a follow-up visit. The patient repeatedly fails to show up for the follow-up visit. Which of the following is the best approach to inform the patient of the need and urgency for a repeat test?

A voicemail or text message.

A visit to her home.

An e-mail message marked as “urgent”.

A certified letter.

Question

A 26-year-old male presents with a chief complaint of bilateral, intermittent itchy eyes accompanied by rope-like discharge. This is most consistent with conjunctivitis caused by:

A virus.

Bacteria.

Over-exposure to smoke.

Allergen.

Question

When developing a management plan for patients with genitourinary infections, which of the following would you most likely recommend for follow-up imaging following resolution of their infection?

A 27-year-old nonpregnant woman with acute, uncomplicated urinary tract infection (UTI).

A 38-year-old nonpregnant woman with 2 acute, uncomplicated UTIs in the past 9 months.

A 57-year-old man with acute bacterial prostatitis.

A 43-year-old man with type 2 diabetes mellitus and recurrent pyelonephritis.

Question

s. Wang is a 56-year-old female who was seen 2 weeks ago for evaluation of ongoing abdominal discomfort and nausea. Laboratory assessment revealed H. pylori and she was treated for peptic ulcer disease with an appropriate antibiotic/proton-pump inhibitor combination. She returns today and admits to no real change in her symptoms. This suggests that:

Treatment was inadequate and a salvage regimen should be used.

It is too soon to expect a response and the patient should be reevaluated in four weeks.

The patient could have complicated peptic ulcer disease and should be referred for endoscopy.

Peptic ulcer disease is likely not the correct diagnosis.

Question

The NP is called to evaluate Jane, a 43-year-old woman, who presents with a diffuse maculopapular rash that began on the trunk but now covers the entire body, including the palms and soles. The rash is not itchy but wart-like sores are present in the mouth and genital area as well as skin folds. Initial evaluation reveals generalized lymphadenopathy and a low-grade fever, and she complains of lethargy and headache. The patient reports that she had a painless genital ulcer that healed on its own about 3 weeks earlier. Which of the following is the most likely diagnosis?

Primary syphilis.

Secondary syphilis.

Genital herpes.

Gonorrhea.

Question

A 27-year-old man presents with a chief concern of an abnormal mass within his left scrotum. He describes it as feeling like a “bag of worms” and is present when he is standing but disappears when he lies down. His past medical history is unremarkable and his BMI is 29 kg/m 2 . He has been in a monogamous relationship for the past 4months. The most likely diagnosis is:

Testicular torsion.

Syphilis.

Varicocele.

Testicular cancer.

Question

An 18-year-old man is being evaluated for a severe exacerbation of asthma. He is currently taking an inhaled corticosteroid, a long-acting beta-agonist, and a short-acting beta-agonist on an as needed basis. The most important component of the initial assessment includes a(n):

Continuous pulse oximetry reading

Peak expiratory flow reading

Chest X-ray

Arterial Blood Gas

Question

A 67-year-old man is being evaluated for shortness of breath. His medical history reveals that he experienced a myocardial infarction about 2 years ago and a history of hypertension, which is well controlled by diet.. Otherwise, his medical history is unremarkable. Which of the following would you expect to find on electrocardiogram (ECG)?

T wave inversion.

Pathologic Q wave.

ST segment elevation.

Tall R wave.

Question

A 46-year-old man is rushed to the emergency department while experiencing an acute adrenal crisis that presents with abdominal pain, severe vomiting, and low blood pressure. He appears cyanotic and confused. The most appropriate treatment for this patient is an injection of:

Insulin.

Epinephrine .

Hydrocortisone.

Antihistamine.

Question

A 74-year-old male with asymptomatic atrial fibrillation underwent electrical cardioversion that successfully restored the heart’s rhythm. Which of the following medications can be considered for the purpose of maintaining the heart’s rhythm?

Sotalol (Betapace ® )

Digoxin (Lanoxin ® )

Dabigatran (Pradaxa ® )

Enalapril (Vasotec ® )

Question

In considering the use of an inhaled anticholinergic, such as tiotropium bromide (Spiriva ® ), for the treatment of chronic obstructive pulmonary disease (COPD), the NP recognizes which of the following is the desired therapeutic action?

Mucolytic agent.

Bronchodilator.

Increases mucociliary clearance.

Antihistamine effect.

Question

A 14-year-old male is brought in for evaluation after he reportedly collapsed during a tennis match, though he quickly regained consciousness. His medical history is otherwise unremarkable. You suspect hypertrophic cardiomyopathy. Which of the following heart murmur characteristics would support the diagnosis?

Occurs late in systole.

Widely split S₂.

Becomes louder when going from a supine to standing position.

Murmur follows mid-systolic click.

Question

You see a 64-year-old man with an area of erythema concentrated on the left side of his neck with clusters of vesicles forming a line. He reported pain in the area a couple of days before the eruption of the lesions. He states that he recently initiated biologic therapy for rheumatoid arthritis. Which of the following is the most likely diagnosis?

Impetigo.

Herpes zoster.

Drug-related adverse reaction.

Viral exanthem.

Question

Gary is a 63-year-old African American male who has been treated for hypertension with ACE inhibitor monotherapy for the past 6 weeks. Despite Gary’s insistence that he is taking his medication as directed, his blood pressure continues to be elevated. Gary mentions that he prefers not having to take multiple medications each day due to cost and convenience. Which of the following is the most appropriate course of action?

Continue with the current regimen as the full effects are not observed until about 8 weeks of treatment.

Add an angiotensin receptor blocker (ARB) to the regimen.

Switch to a beta blocker.

Switch to a calcium channel blocker.

Question

An NP’s duty of care can be established:

Only in the setting of a healthcare institution (e.g., hospital, clinic, etc.).

When the NP gives professional advice or treatment in any setting.

Only when a fee is charged, either to the patient or third-party payer, for services.

Only when both the NP and patient acknowledge a patient-provider relationship.

Question

The NP is called to evaluate a 48-year-old man who was brought to the emergency department after experiencing severe low back pain following an attempt to lift heavy furniture. He also reports a coincident loss of bowel and bladder control. This most likely indicates:

Sciatic nerve entrapment

Vertebral fracture

Cauda equina syndrome

Muscular spasm

Question

A 49-year-old woman presents with a 3-day history of burning during urination, a thin and grayish-white vaginal discharge, and vagina itching. On laboratory examination, you expect to find all of the following except:

Abundant white blood cells

Clue cells

Pseudohyphae

Alkaline vaginal pH

Question

The NP is called to evaluate a 34-year-old nonpregnant woman who complains of a 4-week history of anxiety, palpitations, diarrhea, unexplained weight loss, and sensitivity to heat. Her medical history is unremarkable and she is not taking any medications. Physical examination reveals warm, moist skin and exaggerated deep tendon reflexes. The NP suspects Graves’ disease. Which of the following laboratory results would best support this diagnosis?

Free T₄ =6 pmol/L (NL=10–27 pmol/L).

Thyroid stimulating hormone (TSH)=0.05 mU/L (NL=0.15–4.0 mU/L).

ESR=37 mm/h (NL <15 mm/h).

Total WBC=4,200/mm³, 10% Neutrophils w/ hypersegmentation (NL=6,000–10,000/mm³ , 50%–70% Neutrophils).

Question

Phyllis is a 34-year-old woman who presents for a chief complaint of a migraine resulting in nausea and vomiting. She reports that she experiences multiple migraines each month. She is given a prescription for sumatriptan (Imitrex ® ) 100-mg tablets orally to treat acute migraine pain. When counseling Phyllis about the medication, the nurse practitioner advises about all of the following adverse effects except:

Sedation

Chest tightness

Dry mouth

Nausea/vomiting

Question

In managing a 58-year-old woman who is admitted for deep vein thrombosis, caution should be used with which of the following medications due to a risk of drug-induced thrombocytopenia?

Warfarin (Coumadin®)

Clopidogrel (Plavix®)

Dabigatran (Pradaxa®)

Unfractionated heparin

Question

A 77-year-old woman with urinary incontinence is brought in by her caregiver for evaluation of a potential urinary tract infection. She is mentally alert and responds clearly to questions. The caregiver waits in the waiting area. While performing a routine comprehensive physical examination, you notice bruises on her right and left upper arms. The most appropriate approach would be to say:

“Did someone grab you here?”

“I’m concerned about your safety regarding these bruises on your arms.”

“I notice you have similar bruising on both arms.”

“Shall I ask your caregiver about these bruises?”

Question

A 27-year-old woman with a known sulfa allergy presents with an uncomplicated UTI. She has not received any systemic antimicrobials in the past 6 months. She is currently not pregnant and is using norelgestromin/ethinyl estradiol patch (Ortho Evra ® ) for birth control. You recommend treatment with:

Trimethoprim-sulfamethoxazole (Bactrim ® ).

Amoxicillin (Amoxil ® ).

Nitrofurantoin (Macrobid ® ).

Cephalexin (Keflex ® ).

Question

You are examining a 64-year-old woman with a history of rheumatic heart disease. In assessing the patient for mitral stenosis, you expect to find a heart murmur characterized as:

High-pitched blowing systolic murmur heard best a third left intercostal space.

Late systolic crescendo murmur with honking quality heard best at apex.

Localized low-pitch late diastolic heard best at apex.

Early diastolic murmur heard best at left sternal border with radiation to the neck.

Question

21-year-old female student presents at the university clinic with a nosebleed. This is her third bleeding episode in the past week. She is otherwise healthy with no history of bleeding disorders. The NP advises that the appropriate first-line intervention for anterior epistaxis is:

Nasal packing.

Application of topical thrombin.

Firm pressure to the area superior to the nasal alar cartilage.

Utilization of a dehumidifier at home.

Question

Tertiary prevention activities for a 69-year-old woman with congestive heart failure and type 2 diabetes mellitus include:

Adjusting therapy to minimize dyspnea.

Administering the pneumococcal vaccine.

Skin survey for pre-cancerous lesions.

Assessing her creatinine clearance.

Question

You see a 77-year-old male for treatment of a laceration on his forearm. Upon examination, you notice poor skin turgor when assessed on the arms and back of the hands. This is likely a sign of:

Dehydration.

Normal age-related change.

Early heart failure.

Renal dysfunction.

Question

All of the following practices are recommended when prescribing medications with confusing or similar-sounding names except:

Writing the purpose of the medication on the prescription order.

Considering selecting medications without nomenclature problems.

Including either the generic or brand name on the prescription order, but not both.

Providing patients with written information about their drugs.

Question

Which of the following describes the ethical principle of veracity?

Healthcare resources are allocated so that the best is done for the greatest number of people.

The responsibility of the healthcare provider is to treat all people in the same fair manner.

The healthcare provider must be truthful and avoid deception.

The healthcare provider has an obligation to be faithful to commitments made to self and others.

Question

Which of the following examples describes a potential malpractice scenario?

A patient with known penicillin allergy is prescribed amoxicillin but no allergic reaction occurs.

A post-myocardial infarction patient is prescribed an inappropriate dose of clopidogrel and experiences a severe bleeding episode.

A patient with a urinary tract infection does not see any improvement in signs and symptoms 3 days after given a dose-appropriate prescription for trimethoprim-sulfamethoxazole.

A patient realizes prior to taking any of the medication that the wrong drug was dispensed at the pharmacy.

Question

An 84-year-old female patient is admitted from a local long-term care facility (illnes). The patient is normally awake, alert, and oriented. She resides in the LTCF because she has not fully recovered from a broken hip resulting from a fall 4 months ago; otherwise she is in relatively good health. She can walk short distances with a walker, though she primarily stays in a wheelchair. Today, however, the nursing staff found her to be acutely confused and unable to ambulate without falling. She was transferred to the emergency department for evaluation. Initial laboratory testing must include:

2 sets of blood cultures.

Serum thyroid stimulating hormone (TSH) level.

Urinalysis.

Lumbar puncture.

Question

A 67-year-old female has a long history of chronic venous insufficiency (CVI) and was seen by the nurse practitioner for brown discoloration on her calves. The nurse practitioner diagnoses hyperpigmentation due to CVI and presented the appropriate treatment plan. When evaluating the patient’s understanding, the nurse practitioner expects that she will say:

“I should stay out of the sun or use sunscreen when my legs must be exposed.”

“I need to elevate my legs as often as I can.”

“I will use hydrocortisone cream twice a day for the next two weeks and then come back for my appointment.”

“There is really nothing to help this discoloration.”

Question

The NP is called to evaluate a 56-year-old man complaining of severe pain in the upper right abdomen that radiates to the right shoulder, nausea and vomiting, which started soon after dinner. The NP suspects acute cholecystitis. All of the following findings would be consistent with the diagnosis except:

Elevated aminotransaminase (AST)

Elevated alkaline phosphatase (ALP)

Microcytic anemia

Leukocytosis

Question

A 43-year-old woman presents in the emergency department with a chief complaint of swelling of the ankles, hands, and face. She also reports urine that is darkly colored and foamy. Her blood pressure is 184/118 mm Hg. All of the following urinalysis findings will support a diagnosis of glomerulonephritis except:

Elevated levels of ketones.

Presence of white blood cells.

Elevated levels of protein.

Presence of red blood cell casts.

Question

While conducting an examination of a 15-year-old female accompanied by her mother regarding a potential sexually transmitted disease, the NP knows that the best approach to the visit would be to:

Ensure the mother is present at all times.

Ask the adolescent if she wishes the mother to be included in the interview and examination.

Interview the adolescent with the mother and then asking the mother to leave for the physical examination.

Interview and examine the adolescent in the absence of the mother.

Question

A 23-year-old college student presents with a 2-day history of severe sore throat and difficulty eating or drinking due to trouble swallowing. A physical examination reveals exudative pharyngitis and minimally tender anterior and posterior cervical lymphadenopathy. The NP suspects infectious mononucleosis and would expect which of the following laboratory findings?

Neutrophilia with reactive forms.

Thrombocytosis.

Lymphocytosis with atypical lymphocytes.

Diminished ALT/AST levels.

Question

A 45-year-old male is being prepared for release after receiving analgesic treatment for low back pain due to an acute lumbosacral strain. He is in otherwise good health and typically exercises on a daily basis. He asks when he will be able to start exercising again. The most appropriate response is:

You should not exercise until you are completely pain-free.

Conditioning exercises should be started immediately.

Leg numbness is to be expected with muscle-strengthening exercises.

Back-strengthening exercises may cause mild muscle soreness.

Question

Mrs. Gonzalez is a 53-year-old female who is being evaluated for routine follow-up care. Her medical history includes dyslipidemia, hypertension, and rheumatoid arthritis. Laboratory analysis reveals elevated serum alanine transaminase (ALT) and aspartate transaminase (AST). The long-term use of which of the following medications is the most likely cause of this finding?

Calcium channel blocker

Statin

ACE inhibitor

Methotrexate

Question

“Incident-to” services are defined as those which are “an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness”. As long as certain criteria are met, “incident to” billing is an option in all of the following settings except:

Office visits.

Hospital.

Nursing home.

Home visits.

Question

A 78-year-old male is being treated for a hypoglycemic episode. He has a long history of type 2 diabetes mellitus as well as congestive heart failure and COPD. He is currently taking basal insulin with a sulfonylurea. What is the acceptable A1C goal for this patient?

≤6.5%

≤7.0%

≤8.0%

≤9.0%

Question

A 47-year-old woman reports that her long-time boyfriend was recently diagnosed with liver cancer possibly caused by a chronic hepatitis B infection. Though she does not have any symptoms, she wants to be checked for hepatitis B. She can’t recall if she has ever been vaccinated for hepatitis B. The laboratory results are as follows:

Hepatitis B surface antigen (HBsAg): Positive Hepatitis B surface antibody (Anti-HBs): Negative Total hepatitis B core antibody (Anti-HBc): Positive IgM antibody to hepatitis B core antigen: Negative These findings are most consistent with:

Evidence of effective hepatitis B immunization.

Evidence of hepatitis B infection in the past.

Immunity against future hepatitis B infection.

Chronic hepatitis B.

Question

You see a 74-year-old male who is accompanied by his granddaughter who lives with him. He has hypertension, a prior myocardial infarction, long-standing type 2 diabetes, and recently underwent a lower limb amputation secondary to diabetes. He is currently taking an ACE inhibitor, statin, low-dose aspirin, biguanide, and insulin. The granddaughter reports that since the amputation, her grandfather sometimes becomes withdrawn, irritable and moody for no apparent reason, does not want to participate in the typical activities he enjoys, and often does not appear to eat much during the day. She also states that he often complains of being tired but normally wakes up in the early morning hours. The most appropriate action is to evaluate the patient for:

Dementia.

Depression.

Delirium.

Drug interaction.

Question

A 15-year-old male is brought in to the emergency department by his parents following a 12-hour history of nausea, vomiting, and abdominal pain. Physical examination reveals obturator and psoas signs and a temperature of 102.6ºF (39.2ºC). Anticipated white blood cell (WBC) with differential results are as follows:

Total WBC=18,100/mm 3 , Neutrophils=50%, Bands=1%, Lymphocytes=40%

Total WBC=14,000/mm 3 , Neutrophils=55%, Bands=3%, Lymphocytes=38%

Total WBC=4,500/mm 3 , Neutrophils=35%, Bands=2%, Lymphocytes=45%–55% with reactive forms

Total WBC=16,500/mm 3 , Neutrophils=66%, Bands=8%, Lymphocytes=22%

Question

A 42-year-old male presents with a sudden onset of inability to tightly close the eye lid, frown, or smile on the right side. His examination is otherwise unremarkable and past medical history is unremarkable. This likely represents paralysis of cranial nerve (CN):

III

VII

VIII

Question

Which of the following activities best demonstrates fulfillment of the nursing leadership role?

Screening a 36-year-old woman for hypertension.

Collaborating with a local health clinic on strategies to improve adult vaccination rates.

Volunteering to teach a group of high school students about the dangers of prescription drug abuse.

Collaborating with an infectious disease specialist on the care of a patient with community-acquired pneumonia.

Question

In considering treatment for Jane in the previous question, which of the following would be most appropriate if she has a history of penicillin allergy?

Amoxicillin (Amoxil ® ).

Doxycycline (Doryx ® ).

Famciclovir (Famvir ® ).

Ciprofloxacin (Cipro ® ).

Question

A 17-year-old high school wrestler presents with an 8 cm-diameter area of warm, red, edematous area on his left arm with sharply demarcated borders. The patient is otherwise healthy and without fever. Given a concern for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection, the most appropriate treatment option for this patient is:

High-dose amoxicillin (Amoxil ® ).

Amoxicillin-clavulanate (Augmentin ® ).

Trimethoprim-sulfamethoxazole (Bactrim ® ).

Daptomycin (Cubicin ® ).

Question

You see a 58-year-old man who complains of a persistent dry, hacking cough. He reports that he recently started taking a medication to treat high blood pressure. He is most likely taking a(n):

Angiotensin-converting enzyme (ACE) inhibitor

Alpha-adrenergic antagonist

Angiotensin receptor blocker

Beta-adrenergic antagonist

Question

A 77-year-old woman is accompanied by her husband for evaluation. She is currently being treated with metoprolol (Lopressor ® ) for hypertension and digoxin (Lanoxin ® ) for atrial fibrillation. He reports that his wife is becoming increasingly forgetful over the past year, failing to note important family events such as birthdays, and sometimes becomes confused with driving directions to familiar locations. She has no previous psychiatric history. The most likely diagnosis is:

Parkinson’s disease.

Delirium.

Dementia.

Early stage of congestive heart failure.

Question

The NP is called to evaluate a 51-year-old man with acute bacterial rhinosinusitis. He currently smokes 1 PPD and has a 30 pack-year cigarette smoking history. His medical history shows that he is allergic to penicillin. Two weeks ago, he was treated with a macrolide for “bronchitis”. You now prescribe:

Clarithromycin (Biaxin ® ).

Levofloxacin (Levaquin ® ).

Cephalexin (Keflex ® ).

Amoxicillin-clavulanate (Augmentin ® ).

Question

Which of the following is most consistent with the hepatic enzyme profile of a person with non-alcoholic fatty liver disease?

AST=1208 U/L, ALT=560 U/L.

AST=45 U/L, ALT=88 U/L.

AST=678 U/L, ALT=990 U/L.

AST=98 U/L, ALT=149 U/L.

Question

A 32-year-old woman in her second trimester of pregnancy presents with fever, flank pain, and hematuria. The NP suspects pyelonephritis. Which of the following urinalysis results would be most indicative of pyelonephritis?

>100 red blood cells (RBCs) per high power field (HPF)

Protein ≥300 mg/dL

White blood cell (WBC) casts

Ketones

Question

Laboratory findings of a 28-year-old male suspected of heatstroke can include all of the following except:

Hyperkalemia.

Elevated total creatine kinase.

Hypernatremia.

Leukocytosis.

Question

Mrs. Conner is a 76-year-old woman living in a long-term care facility and has been bedridden with a respiratory infection for the past 4 days. She is brought in for evaluation and you note signs of dehydration as well as a section of epidermal skin loss about 3 cm in diameter on her right hip. The dermal layer appears intact. This would be considered a pressure ulcer of Stage:

Question

Which of the following represents the highest level of scientific evidence when evaluating clinical research?

A randomized controlled trial.

Systematic review/ Meta-analysis of randomized controlled troals.

Observational study.

Cohort study.

Question

A 24-year-old with a history of major depressive disorder is rushed to the emergency department by his friends after taking an overdose of antidepressant medication. The ingestion of which of the following medications poses the greatest risk of death for this patient?

A 4-day supply of diazepam (Valium ® )

A 3-week supply of Bupropion (Wellbutrin ® )

A 2-week supply of nortriptyline (Pamelor ® )

A 3-week supply of duloxetine (Cymbalta ® )

Question

The NP is called to evaluate a 72-year-old woman with community-acquired pneumonia. Her vital signs include temperature 101.6ºF (38.7ºC), BP 106/68 mm Hg, and heart rate 78 bpm. Physical examination reveals increased tactile fremitus and dullness to percussion at the left lung base. These findings are consistent with:

Cavitation

Pneumothorax

Lung abscess

Consolidation

Question

A 64-year-old woman with chronic kidney disease presents with a chief complaint of lethargy. His hemogram is as follows: -Hemoglobin (Hg)=9.9 g/dL (12–14 g/dL -Hematocrit (Hct)=30% (36%–42%) -Mean cell volume (MCV)=81 fL (80–96 fL -Reticulocytes=0.7% (1%–2%) These findings are most consistent with:

Iron deficiency anemia.

Anemia of chronic disease.

Folate deficiency anemia.

Thalassemia trait.

Question

The NP is called to evaluate a 57-year-old man who reports episodes of acute angina with physical exertion. He is currently taking an ACE inhibitor and low-dose aspirin. The NP considers which of the following approaches at the start of anginal symptoms?

An oral dose of a P2Y 12 inhibitor.

An extra dose of the ACE inhibitor.

A dose of nitroglycerin via sublingual spray.

Supplemental oxygen therapy for 10 minutes.

Question

You see a 71-year-old man with atrial fibrillation and chronic obstructive pulmonary disease (COPD) who is diagnosed with community-acquired pneumonia. His medical history does not show any drug allergies and he completed a course of a respiratory fluoroquinolone for the treatment of acute bacterial sinusitis within the past month. Which of the following would you consider the most appropriate choice of antimicrobial?

Cefpodoxime (Vantin ® )

Amoxicillin (Amoxil ® ) with doxycycline (Doryx ® )

Azithromycin (Zithromax ® )

Moxifloxacin (Avelox ® )

Question

A 27-year-old woman is being evaluated for a 7-day history of acute bacterial rhinosinusitis. She is otherwise healthy and has not received any antimicrobial therapy in the past 6 months. She also has no history of drug allergy. In considering a first-line antimicrobial treatment, all of the following would be appropriate except :

Amoxicillin (Amoxil ® ).

Cefuroxime (Ceftin ® ).

Azithromycin (Zithromax ® ).

Levofloxacin (Levaquin ® ).

Question

When managing elderly patients with diminished cognitive function, which of the following statements is true regarding patient competence for making informed healthcare decisions?

First-degree relatives can declare a person incompetent.

Healthcare providers do not have the ability to determine whether a patient can provide informed consent.

A pattern of impaired judgment can be used to declare a patient incompetent.

Only a court can appoint a guardian to make decisions for a patient declared incompetent.

Question

n 18-year-old female is being evaluated for wheezing that occurs on an intermittent basis. Symptoms occur about 3–4-times weekly, but not daily. Nighttime awakenings due to wheezing or coughing occur about once per week. Her FEV 1 is 85% predicted and Asthma Control Test (ACT) score is 22. The patient is diagnosed with mild persistent asthma and initiated on Step 2 treatment, which will include:

Short-acting beta 2 -agonist (SABA) on an as needed basis only.

Low-dose inhaled corticosteroid (ICS) only.

Medium-dose ICS plus LABA.

LABA only.

Question

A 57-year-old female presents for a flu shot as she has heard reports that it will be “a bad flu season”. She has had no primary care for more than 10 years as she lacked health insurance. She admits to a 30 pack-year cigarette smoking history, currently smoking 1 pack-per-day (PPD). Her history and examination are unremarkable. Which screening test will you recommend?

Sputum cytology

Mammography

Hemoglobin electrophoresis

Fasting serum triglycerides

Question

A 46-year-old woman presents with a 12-hour history of fever, severe pain in the upper right abdomen, and positive Murphy’s sign. Her medical history is unremarkable and she is in otherwise good health. The most likely diagnosis is:

Appendicitis.

Chronic cholelithiasis.

Acute cholecystitis.

Acute viral hepatitis.

Question

You see a 68-year-old woman who is being treated for moderate depression. She complains that her medication is causing symptoms of dry mouth and constipation. She is most likely taking which of the following medications?

Venlafaxine (Effexor ® )

Citalopram (Celexa ® )

Fluoxetine (Prozac ® )

Nortriptyline (Pamelor ® )

Question

Bill is a 46-year-old man who is rushed to the emergency department after experiencing sudden onset of edema of the lips and face and a sensation of “throat tightness and difficulty breathing” following a wasp sting. His blood pressure is 78/52 mm Hg, heart rate 120 bpm, and respiratory rate 32/min. The first course of action in caring for Bill is to administer:

Diphenhydramine (Benadryl ® ).

Epinephrine (EpiPen ® ).

Nitroglycerin (Nitrolingual ® ).

Ranitidine (Zantac ® ).

Question

You are evaluating a 44-year-old woman with community-acquired pneumonia. She has no comorbidities, no reported history of drug allergy, and has not received any antimicrobial therapy in the past 6 months. Which of the following is the most appropriate treatment choice?

Ceftriaxone (Rocephin ® ).

Azithromycin (Zithromax ® ).

Linezolid (Zyvox ® ).

Moxifloxacin (Avelox ® ).

Question

Bettie is a 33-year-old mother of two children who presents for treatment of a lower urinary tract infection. This is her third episode in the past 6 months. She is prescribed appropriate antibiotic therapy and is taught strategies to decrease urinary tract infection. Which of the following is recommended for the prevention of recurrent UTI in at-risk patients?

Voiding before and after coitus.

Drinking two glasses of cranberry juice each day.

Use of lactobacillus probiotics.

Continuous low-dose antimicrobial prophylaxis.

Question

A 26-year-old woman presents with uncomplicated UTI. She is otherwise healthy, has not received any systemic antimicrobials in the past year, does not have a sulfa allergy, and is not taking any medications. She is currently not pregnant and is using etonogestrel/ethinyl estradiol vaginal ring (NuvaRing ® ) for contraception. The local E. coli resistance rate to TMP/SMX is about 12%. The preferred therapy for this patient is:

Trimethoprim-sulfamethoxazole (Bactrim ® ).

Amoxicillin (Amoxil ® ).

Nitrofurantoin (Macrobid ® ).

Cephalexin (Keflex ® ).

Question

A 78-year-old man is brought in by his neighbor who reports that she found him sitting in the front yard. She reports that he mumbled something about waiting for his wife, though she passed away more than 10 years ago. The neighbor says that the patient lives by himself and that this is the first time he has acted in this manner. The patient is calm but has trouble understanding simple directions and is unable to respond promptly to simple questions. Suspecting delirium, the most appropriate first course of action is to:

Administer an antipsychotic.

Refer for neurological consult.

Identify the underlying illness.

Order a head computed tomography (CT) scan with contrast.

Question

A 19-year-old college freshman has been urged by her friends to be evaluated for lethargy, loss of appetite, and hypersomnia over the past 2 weeks. You administer the Beck Depression Inventory (BDI) assessment and she scores a 22. This would indicate:

No depression.

Mild depression.

Moderate depression.

Severe depression.

Question

The healthcare principle that promotes actions that lead to achieving the greatest good for the greatest number is known as:

Autonomy.

Utilitarianism.

Beneficence.

Fidelity.

Question

A 43-year-old man who smokes 1 pack-per-day (PPD) and has an 18 pack-year smoking history presents with a chief complaint of increasing shortness of breath, chronic cough, and sputum production. In considering chronic obstructive pulmonary disease (COPD), which of the following would most support the diagnosis?

FEV₁ >70% predicted.

FEV₁ <85% predicted.

FEV₁/FVC <0.70.

FEV₁ /FVC <1.0.

Question

A 75-year-old man presents with chief complaints of headache, nausea, and muscle weakness. His creatinine level is 2.1 mg/dL (185.6 μmol/L) and GFR is 30 mL/min/1.73 m 2 . He currently takes a thiazide diuretic for the management of hypertension. Which of the following statements is false regarding the use of diuretics in the elderly?

Thiazide diuretics are less effective when creatinine level is ≥1.8 mg/dL (159.1 mol/L).

Thiazide diuretic use is an independent risk factor for the development of type 2 diabetes mellitus.

Loop diuretics are contraindicated when GFR is ≤40 mL/min/1.73 m².

Thiazide diuretic use leads to low volume sodium depletion resulting in peripheral vascular resistance (PVR) reduction.

Question

All of the following persons are eligible for Medicare services except:

A 74-year-old ex-smoker with COPD and high income from assets.

A 69-year-old undocumented resident in the US with atrial fibrillation.

A 62-year-old with a permanent physical disability due to a motor vehicle accident.

A 72-year-old permanent legal resident (non-US citizen) with type 1 diabetes mellitus.

Question

A 35-year-old woman presents with a chief complaint of being unable to close her right eyelid tightly, frown, or smile on the right side. She is otherwise healthy with no significant prior medical history. An appropriate diagnostic test for this patient would be:

Erythrocyte sedimentation rate (ESR).

Alanine transaminase/aspartate transaminase (ALT/AST) levels.

Lyme disease antibody titer.

Thyroid stimulating hormone (TSH) level.

Question

A 23-year-old man is admitted after experiencing a seizure. A witness to the seizure described how the patient fell to the ground with rigid extension of the arms and legs that was then followed by a period of jerking movements and loss of consciousness. This best describes which type of seizure?

Petit mal.

Myoclonic.

Tonic-clonic (grand mal).

Complex partial.

Question

A 54-year-old man is being evaluated for pain related to acute bacterial prostatitis. In considering the diagnosis and management, the NP realizes that:

Gram-positive organisms are the most common cause of infection.

Length of antibiotic therapy is usually 1 week.

Perineal pain with defecation is a common complaint.

Cephalosporins are first-line therapy.

Question

A 25-year-old landscaper with a 6 cm abscess on the left upper arm presents one week post incision and drainage for a follow-up appointment. The area is much improved, but has some residual erythema and discomfort. The nurse practitioner correctly interprets that:

The healing process is proceeding normally and he should continue to monitor progress.

The presence of discomfort one week after incision and drainage suggests residual infection and antibiotics should be started.

The wound should be packed with iodoform gauze and irrigated with normal saline twice daily.

The patient should be referred for a surgical evaluation.

Question

The Privacy Rule established by the U.S. Department of Health and Human Services in 1996 implemented the requirements for:

Electronic medical records at every healthcare institution.

Health Insurance Portability and Accountability Act (HIPAA).

Expanding Medicare to those <65 years of age who meet certain criteria.

Mandatory psychological screening for all Federal employees.

Question

In the patient diagnosed with infectious mononucleosis, the use of amoxicillin should be avoided due to the risk of:

Resistance development.

Rash.

Stevens-Johnson syndrome.

Toxic epidermal necrolysis.

Question

When initiating therapy with spironolactone for a patient who is also on an ACE inhibitor, you advise the patient to return in 5 days to check which of the following laboratory parameters?

Sodium

Calcium

Potassium

Chloride

Question

A 27-year-old male is rushed to the emergency department after experiencing a series of seizures. He has no history of neurologic disorder. His girlfriend states that he was taking multiple medications for mood disorder but recently stopped taking one of them. The most likely medication the patient discontinued is a:

Selective serotonin reuptake inhibitor (SSRI).

Serotonin-norepinephrine reuptake inhibitor (SNRI).

Benzodiazepine.

Second-generation tricyclic antidepressant.

Question

When considering an end-of-life decision for a terminally ill person with Alzheimer-type dementia who can no longer communicate, all of the following can be used as an advanced directive except:

Testimony from a family member or close friend

A living will.

A “do not resuscitate” order.

A durable power of attorney for healthcare.

Question

Which of the following types of clinical studies represents the lowest level of evidence used to guide medical decisions?

Clinical experience of renowned expert in field.

Non-randomized controlled study.

Observational study.

Case-control study.

Question

Which of the following electrocardiogram (ECG) changes do you expect to find in a person with myocardial ischemia?calcium

Pathologic Q wave

Tall R wave

T wave inversion

ST segment elevation

Question

You see a 62-year-old woman experiencing a painful episode of acute gouty arthritis. All of the following are appropriate treatment choices to relieve her condition except:

Naproxen sodium (Aleve ® ).

Intraarticular corticosteroid injection.

Allopurinol (Aloprim ® ).

Colchicine (Colcrys ® ).

Question

As part of the Deficit Reduction Act of 2005, Medicare will incorporate quality payment adjustments for certain hospital-acquired conditions, including all of the following except:

Catheter-associated urinary tract infection.

Myocardial ischemia.

Pressure ulcers.

Deep vein thrombosis.

Question

In which of the following situations is parental consent usually needed prior to treatment?

A 15-year-old requesting information about contraception.

A 17-year-old who wants help with anxiety.

A 16-year-old requesting treatment for acne vulgaris.

An 18-year-old who requires treatment for depression

Question

A 17-year-old male with intermittent asthma presents for routine follow-up. He explains that he experiences asthma symptoms once or twice each week, usually during physical activity. Symptoms are promptly relieved each time with albuterol per MDI with spacer. He does not report any nighttime awakenings due to his asthma. His ACT score is 24 and vital signs are all within normal limits. According to the NAEPP EPR-3, what is the next step in the management of his asthma?

Continued use of SABA on an as needed basis.

Initiation of a long-acting beta-agonist.

Initiation of low-dose inhaled corticosteroids.

Restrict physical activity.

Question

A 41-year-old woman is diagnosed with hypertension that requires medication. She is otherwise healthy but currently taking drospirenone/ethinyl estradiol (Yasmin ® ) for birth control. Which of the following antihypertensive medications would be least preferred for this patient?

Beta-adrenergic antagonist

Angiotensin-converting enzyme inhibitor

Calcium channel blocker

Angiotensin receptor blocker

Question

A 71-year-old male presents to the emergency department. He is complaining of severe abdominal pain in the right lower quadrant. Diagnostic findings to support a ruptured appendix would include all of the following except:

Leukopenia.

Fever >102ºF (>38.9ºC).

Symptoms lasting more than 48 hours.

Absence of bowel sounds.

Question

A 57-year-old woman presents with a 6-month history of numbness of the fingertips and oral irritation. Physical examination reveals pale conjunctiva and a heart murmur. She is otherwise healthy, exercises regularly, has a BMI of 22 kg/m 2 , and she states that she is a vegan. Hemogram results are as follows: -Hg=8.2 g/dL (12–16 g/dL) -Hct=23% (36%–42%) -MCV=135 fL (80–96 fL) -Red blood cell distribution width (RDW)=17% (11%–15%) These findings are most consistent with:

Hemolysis.

Vitamin B12 deficiency.

Iron deficiency.

Anemia of chronic disease.

Question

Which of the following statements is false regarding end-of-life decision-making for a patient that is hopelessly and terminally ill?

A durable power of attorney for healthcare can be used to authorize another person to make healthcare decisions.

A videotaped or audiotaped discussion with the patient can include advanced directives.

Advanced directives are legally binding and recognized in all 50 states.

Living wills and do not resuscitate orders are examples of advanced directives.

Question

You see a 24-year-old woman of Asian ancestry who is being evaluated for a neurologic disorder. A thorough laboratory analysis is conducted and the hemogram results are as follows: -Hemoglobin (Hg)=10.4 g/dL -Hematocrit (Hct)=32% -Mean cell volume (MCV)=71 fL -Red blood cell distribution width (RDW)=13% -Red blood cells (RBC)=5.5 million The most likely condition associated with these hemogram results is:

Acute blood loss.

Beta thalassemia minor.

Iron deficiency anemia.

Cooley’s anemia.

Question

The nurse practitioner is evaluating a 19-year-old male suffering from a severe headache. He has a history of headaches that tend to occur in clusters over a few days. He has unsuccessfully tried several therapeutic modalities. A positive response to which of the following interventions supports the diagnosis of cluster headache?

Oxygen therapy.

Beta-adrenergic blockade.

Tricyclic antidepressant.

Dietary reduction of amines.

Question

A 68-year-old woman who resides in a long-term care facility is being treated for a urinary tract infection. Her medical history includes hypertension, peripheral artery disease, and a 35 pack-year smoking history. During the evaluation, she brings to your attention a painless, pearly nodule on the upper lip. This clinical presentation most likely represents a(n):

Squamous cell carcinoma

Basal cell carcinoma

Actinic keratosis

Molluscum contagiosum

Question

A 23-year-old male patient is evaluated in the early morning hours for nausea with vomiting. He had eaten some food from the fridge the night before that “was probably too old.” The NP suspects acute gastroenteritis and would expect the course of the disease over the next 48–72 hours to involve:

Continued clinical evidence of dehydration, even with proper fluid uptake

Resolution of vomiting but onset of diarrhea

Continued episodes of vomiting but have improved appetite

Complete resolution of symptoms and be feeling well

Question

A 47-year-old man is being evaluated for severe eye pain and sudden onset of reduced visual acuity. The NP suspects acute angle-closure glaucoma. Which of the following is most likely to be found on funduscopic examination to support this diagnosis?

Hemorrhagic lesions.

Low intraocular pressure.

Arteriovenous nicking.

A deeply-cupped optic disc.

Question

A 73-year-old man is being evaluated following an episode of dizziness leading to a fall that did not cause any injury. Cardiac and neurologic examination did not reveal the cause of dizziness. In preparation for discharge planning, the patient undergoes a formal balance assessment using which of the following tests?

Braden scale.

Tinetti assessment.

McMurray test .

Wintrobe criteria.

Question

All of the following are required Medicare terms and conditions for paying NP services except:

The services are within the NP’s scope of practice as defined by state law.

The services performed are those for which a physician would be able to bill Medicare.

The services are performed in collaboration with a physician.

Separate charges are billed for NP services and facility charges.

Question

A 21-year-old college student presents with new-onset pain and swelling in the feet and ankles as well as conjunctivitis, oral lesions, and dysuria. She reports that she has had multiple sexual partners and does not use any form of protection. The most important test result to obtain is:

Rheumatoid factor

Sedimentation rate

Urethral cultures

Question

A 17-year-old male is admitted after experiencing sudden, severe pain in the scrotum during the night. Physical examination reveals swelling of the scrotum and the loss of the cremasteric reflex. His heart rate is 110 bpm, blood pressure 150/80 mm Hg, and temperature 99.8ºF (37.7ºC). This most likely represents:

Testicular neoplasia

Acute epididymitis

Incarcerated hernia

Testicular torsion

Question

You see a 48-year-old man with a chief complaint of pain during urination. Imaging reveals the presence of a kidney stone in the ureter. You consider all of the following management options except:

Increased fluid uptake with water or citrus drinks.

Alpha blocker use.

Thiazide diuretic use.

Analgesia use.

Question

According to the Consolidated Omnibus Reconciliation Act (COBRA), the spouse of an eligible employee will be eligible for COBRA coverage in all of the following circumstances except when the eligible employee:

Divorces the spouse.

Becomes eligible for Medicare.

Has his or her hours reduced.

Is terminated for misconduct.

Question

You see a 14-year-old soccer player with an ankle sprain. Physical examination reveals complete ankle instability, significant swelling, and moderate to severe ecchymosis. You would grade this sprain as:

Grade I.

Grade II.

Grade III.

Grade IV

Question

A 28-year-old male with asthma presents with a chief complaint that he has to use his rescue inhaler multiple times each day. An evaluation reveals that he has moderate-to-severe asthma and requires Step 4 treatment. An appropriate regimen would include:

Low-dose inhaled corticosteroid (ICS)

Medium-dose ICS

Medium-dose ICS plus a long-acting beta₂-agonist (LABA)

High-dose ICS plus LABA plus omalizumab (Xolair ® )

Question

A 19-year-old is diagnosed with meningococcal meningitis. In order to prevent secondary infections among adults who had close contact with the patient, all of the following are recommended except:

Administer appropriate meningococcal vaccine if previously unvaccinated.

Prophylaxis with acyclovir (Zovirax ® ).

Prophylaxis with ciprofloxacin (Cipro ® ).

Prophylaxis with Ceftriaxone (Rocephin ® ).

Question

You see a 26-year-old man with moderate persistent asthma who is experiencing a severe exacerbation. Which of the following would you most likely expect when evaluating this patient?

Crackles.

Inspiratory wheeze.

Expiratory wheeze.

Bradypnea.

Question

A 62-year-old woman presents in the emergency department complaining of severe toe pain that originated overnight. She has a history of renal disease and is currently taking a thiazide diuretic. Her BMI is 37 kg/m 2 . In considering a diagnosis of acute gouty arthritis, the nurse practitioner knows that the best diagnostic indicator is:

Serum uric acid.

Joint X-ray.

Erythrocyte sedimentation rate (ESR).

Analysis of joint aspirate for urate crystals.

Question

Which of the following is the most appropriate antibiotic for a 57-year-old man with acute bacterial rhinosinusitis and who has type 2 diabetes mellitus, COPD and a beta-lactam allergy?

Cephalexin (Keflex ® ).

Amoxicillin-clavulanate (Augmentin ® ).

Trimethoprim with or without sulfamethoxazole (Primsol ® , Bactrim ® ).

Levofloxacin (Levaquin ® )

Question

While taking the history on a 61-year-old female patient, the nurse practitioner learns that she has a 15-year history of poorly-controlled hypertension. The patient admits that another provider had told her that the high blood pressure had affected her eyes. As a result, the nurse practitioner expects that funduscopic examination will likely reveal:

General vessel narrowing

Optic disc atrophy

Macular degeneration

Proliferative retinopathy

Question

A 28-year-old woman presents who complains of tugging chest pain unrelated to physical activity. She is generally in good health, a non-smoker, has a BMI of 23 kg/m², and denies dyspnea or dizziness. Physical examination reveals a grade 2/6 late systolic murmur that follows a midsystolic click at the 5th intercostal space, mid-clavicular line. An echocardiogram fails to reveal mitral valve tissue redundancy. This clinical presentation is most consistent with:

Silent myocardial infarction.

Aortic stenosis.

Mitral valve prolapse.

Atrial septal defect.

Question

A physician employs an NP to provide services at a satellite acute care clinic. If the physician is never present at the clinic, which of the following statements is true?

“Incident to” billing is applicable for the services provided by the NP.

The NP services should be billed under the NP’s provider number.

Medicare will pay 100% of the physician rate for the NP services.

The physician must cosign any documentation of services in order to bill Medicare under the physician’s provider number.

Question

Which of the following describes the ethical principle of beneficence?

The obligation of the healthcare provider to help people in need.

The duty of healthcare provider to do no harm.

The responsibility of the healthcare provider to treat all in the same fair manner.

The right of the competent person to choose a personal plan of life and action.

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Healthcare Information Technology Trends|2025

February 15, 2025/in Nursing Questions /by Besttutor

Make sure it is in APA 7 format and at least 3-4 paragraphs and references.

Throughout history, technological advancements have appeared for one purpose before finding applications elsewhere that lead to spikes in its usage and development. The internet, for example, was originally developed to share research before becoming a staple of work and entertainment. But technology—new and repurposed—will undoubtedly continue to be a driver of healthcare information. Informaticists often stay tuned to trends to monitor what the next new technology will be or how the next new idea for applying existing technology can benefit outcomes.

In this Discussion, you will reflect on your healthcare organization’s use of technology and offer a technology trend you observe in your environment.

To Prepare:

Reflect on the Resources related to digital information tools and technologies.
Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
Reflect on current and potential future trends, such as use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.

By Day 3 of Week 6

Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described. Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described. Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.

By Day 6 of Week 6

Respond to at least two of your colleagues* on two different days, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

*Note: Throughout this program, your fellow students are referred to as colleagues.

In this Discussion, you will reflect on your healthcare organization’s use of technology and offer a technology trend you observe in your environment.

To Prepare:

Reflect on the Resources related to digital information tools and technologies.
Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
Reflect on current and potential future trends, such as use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.

By Day 3 of Week 6

By Day 6 of Week 6

Respond to at least two of your colleagues* on two different days, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

*Note: Throughout this program, your fellow students are referred to as colleagues.

I will be adding two discussions that will need replies. At least 2-3 references each and 2 paragraphs also for each.

Mike’s discussion

With the advent of high speed data and network interface with surging speeds, the introduction of the electronic health record system to the hospital network and the adoption of informatics into the health care sector, some of the noticeable technological trends fostered by the aforementioned developments includes but is not limited to the use of zoom calls for conferences and meetings, the use of information technology to offer opportunities in telephone or video medicine. “An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.” (HealthIT.gov., 2018c)

Given the ease at which the health care sector thrives in the wake of technological and data advancement due to innovation and research, the infrastructures surrounding the smooth running of these innovative ideas are sometimes faced with challenges associated with their use. Some of the potential challenges associated with the use of these ground breaking innovations include but is not limited to adequate man power and staffing to man the system, monitor it and also do necessary repairs when the need arise, the problem of lack of an emergency back up should the primary system experience a problem requiring extensive repairs and or replacement, the need for data collection, inspection, interpretation and utilization presents with an issue if no qualified personnel is available to undertake the duties described above.

Given the premise of the ease of use and the need to pursue enhancement in technology and innovation with regards to the health care sector and patient care safety, one potential benefit associated with data safety, legislation and patient care is the ease at which a patient can get attended to by a physician or a mid level provider at the comfort of their home using either a tele conference approach or a video platform like zoom. The down side or potential risk concomitant with this mode of patient care is associated to cases that require the physical presence of a provider or a physician in cases of emergency where the situation requires a one on one attention as in the case of doing invasive procedures or extensive surgeries. “Telehealth is still a new and evolving technology; while the offsite interventions or contacts often lead to less time being wasted on non – care oriented task because of the efficiencies offered by the technology applications, its use must never be associated with less care.” (McGonigle, 2017, p361)

Following from the disruption in the normal work flow of the health care sector due to the COVID 19 pandemic, some of the health care technology trends I believe are most promising for inputting health care technology in nursing practice include the use of advancements in tele medicine which presents with advantages in no over head or staff to maintain, no rent or space to pay in the case of stand alone private clinics whose owners pay a premium to utilize an assigned space for their respective practices. Given our present global circumstance of COVID 19 pandemic, I will say for the time being, the use of zoom calls and advancements in tele medicine is the best alternative to a face to face contact with a patient, since quite a lot can be accomplished using a phone line and or a video call with the exception of limitations to cases that require invasive approach or emergency intervention like the need to intubate a patient. “In a connected care environment, more citizens are engaging in their health care through mobile apps and social media tools. Given this growing health care engagement, it is important for health care professionals to have the knowledge and skills to evaluate and recommend appropriate digital tools.” (Skiba, 2017)

References

HealthIT.gov. (2018c). What is an electronic health record (EHR)? Retrieved from

https://www.healthit.gov/faq/what-electronic-health-record-ehr

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Skiba, D. (2017). Evaluation tools to appraise social media and mobile applications. Informatics, 4(3), 32–40.

Dea’s Discussion

Main Post

Some of the healthcare technology trends that I have observed in my nursing practice are telehealth and electronic MAR. This electronic technology was created for providers to get information in real-time and it is only accessible to qualified staff. (HealthIT.gov, 2018c). We still paper chart at our detox, mental health hospital so these two technologies are used at work. We have only had electronic MARs for a few years but it does collect data that we use for clinical decisions. One of the challenges of the e-MAR is the lack of knowledge on how to use the system. This is more of a physician problem than a nursing problem although new nurses or PRN nurses who have never used the system or have not been trained enough on the system can find it challenging. When physicians do not know how to use the system correctly they typically put in orders wrong, especially when a patient is on a detox medication taper. This is dangerous because if you have a new nurse or a PRN nurse and a physician who does not know how to use the system, then medication errors can and do happen.

One benefit to the e-MAR is data safety. With the e-MAR, we can scan their armband or look a patient up by their name and date of birth. Once this information is entered by a nurse, the patient’s e-MAR profile comes up and this is where you can go over medications, allergies, or any other important information that needs to be verified. There are also risks when it comes to e-MARs. For example, data safety can be a concern. Even though technology has their patient’s data information as a priority, there are security and privacy issues. For example, how consent is obtained and patient trust plays a part in the safety of data. If trust is not kept, then patients may not be willing to give important information when seeking care (McGonigle & Mastrian, 2017 pp. 284-285).

Another benefit to e-MARs is due to legislation. There is legislation in place to protect patient information. The government uses the American Recovery and Reinvestment Act as legislation. It protects patients by addressing development, adoption, and implementation (McGonigle & Mastrian, 2017 p.149). A risk for data safety for the e-MAR is if a nurse leaves the computer up and on a patient’s profile. Another patient can easily see what is on the screen. This does not provide privacy for the patient. When you are done with the computer, you are supposed to log out of the patient’s file. This is one-way data is not safe.

Lastly, the benefit of having an e-MAR is patient care. The e-MAR allows staff to stay on task with medication distribution. The e-MAR lets the nurses know what medication is due and what the dose is. The e-MAR also provides safety to the patient. If the wrong medication is scanned the system does not allow the nurse to go any further. This allows the nurse to verify what she is scanning is correct. This provides safety in patient care. On the other hand, a risk to patient care is if the system does not have the right allergies put into the system and the wrong medication is given. Many of the patients that come into the hospital are not in the right mind at the time of admission. As a hospital, we rely on the data collected and entered into the system before they receive medications. Collecting data can be a risk to the patient which would lead to poor patient care.

In today’s world, many people in the community are taking responsibility for their healthcare and that is being done by using mobile apps and social media (Skiba, 2017). These technology trends are most promising for impacting nursing practice and impacting patient outcomes. Mobile apps and social media impact nursing practice because they provide a tool to help in educating patients. For example, as you educate your patients, you can guide them to the Center for Disease Control and Prevention (CDC) for further information. Many times, patients do not have questions until a later time and this will allow them to take initiative in their care. These trending technologies are a great tool for nurses to utilize in their practice and will continue to impact their nursing practice. Technology is not going anywhere soon so as nurses, we need to embrace these tools and use them to our advantage. When nurses provide reliable resources, the patients will be less like to surf the web for the answers to their health questions. There are a lot of mobile apps and social media outlets that can lead patients down the wrong path. As nurses, it is our job to know what apps and social media outlets will lead to improving patient outcomes. That being said, it seems that technology trends, the impact of nursing practice, and improving patient outcomes are intertwined.

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Capstone Project|2025

February 15, 2025/in Nursing Questions /by Besttutor

Capstone Project – Developing Smart Goals/Objectives for your Project

In this assignment, you will

1. Find 2 articles on the use of SMART goals/objectives: what are they, how are they used, and why they can be a useful tool. Summarize content of each article by writing a summary paragraph for each.

2. Next, select 3 peer reviewed articles that address your chosen area of focus for you Capstone Project. You will use these to cite your Capstone Project goals/objectives. A table is provided in the assignment document for your use.

3. Lastly, create a minimum of 3 and no more than 5 goals/objectives for your Capstone Project.

Remember: You must use in-text citations and references using correct APA format.

Assignment is due by Saturday 2359 Central Time (CT)

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Advanced Pathophysiology|2025

February 15, 2025/in Nursing Questions /by Besttutor

3 citations APA format 7TH Edition.

Question

A 27-year-old patient with a history of substance abuse is found unresponsive by emergency medical services (EMS) after being called by the patient’s roommate. The roommate states that he does not know how long the patient had been lying there. Patient received naloxone in the field and has become responsive. He complains of burning pain over his left hip and forearm. Evaluation in the ED revealed a large amount of necrotic tissue over the greater trochanter as well as the forearm. EKG demonstrated prolonged PR interval and peaked T waves. Serum potassium level 6.9 mEq/L.

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

· The role genetics plays in the disease.

· Why the patient is presenting with the specific symptoms described.

· The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

· The cells that are involved in this process.

· How another characteristic (e.g. gender, genetics) would change your response.

Response to Discussion PostTop of Form

Meg

Rhabdomyolysis

This patient is presenting with rhabdomyolysis from decreased blood supply to the area that is causing autolysis. Narcan is an antagonist that knocks opioids out of the way within minutes to allow breathing to normalize (U.S. National Library of Medicine, 2019). At first, I was not certain where the importance of the recreational drug use came into play. With further investigation I was able to find that recreation drug use is a contributing factor of ATP production interruption (Cabral et al., 2020). Rhabdomyolysis is indicated by the necrotic tissue and increased serum potassium level results. One of the most serious complications from rhabdomyolysis is hyperkalemia due to release of potassium into the ECF (McCance et al., 2019 p. 1430).

Decreased blood supply to the greater trochanter and forearm caused a decrease in ATP production. The decreased ATP caused increase intracellular calcium (McCance et al., 2019 p.117) As calcium increases, potassium is exchanged, and serum K+ levels rise. With rhabdomyolysis the sodium and calcium pump become dysfunctional and no longer regulates the exchanges correctly. The dysfunctional K+ and Ca++ pump lead to hypokalemia and hypercalcemia within the cell, resulting in hyperkalemia and hypocalcemia in the ECF. As potassium levels continue to rise, velocity of impulse conduction is depressed resulting in prolonged PR interval and peaked T-waves (Rafique et al., 2020).

Hyperkalemia is defined as ECF greater than 5.0mEq/L and severe hyperkalemia is defined as serum levels greater than or equal to 6.0mEq/L (McCance et al., 2019 p.117). Genetics, in my opinion, did not play a role in the development of rhabdomyolysis. Nor would my response change if the case involved a female patient. According to the American Heart Association (2016), hyperkalemia can interfere with proper electric signals in that heart muscle and result in abnormal ECG results.

References

American Heart Association. (2016, October 31). Hyperkalemia (High Potassium). www.heart.org. https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/hyperkalemia-high-potassium.

Cabral, B. M. I., Edding, S. N., Portocarrero, J. P., & Lerma, E. V. (2020). Rhabdomyolysis. Disease-a-Month, 66(8), 101015. https://doi.org/10.1016/j.disamonth.2020.101015

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2019). Pathophysiology: the biologic basis for disease in adults and children (8th ed.). Elsevier.

Rafique, Z., Aceves, J., Espina, I., Peacock, F., Sheikh-Hamad, D., & Kuo, D. (2020). Can physicians detect hyperkalemiabased on the electrocardiogram? The American Journal of Emergency Medicine, 38(1), 105–108. https://doi.org/10.1016/j.ajem.2019.04.036

U.S. National Library of Medicine. (2019, January 15). How Naloxone Saves Lives in Opioid Overdose. Medline

Plus. https://www.bing.com/videos/search?q=pathophysiology of

&&view=detail&mid=E604A1E45A1B6B2EC14DE604A1E45A1B6B2EC14D&&FORM=V

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Critical reasoning week 2 assignment|2025

February 15, 2025/in Nursing Questions /by Besttutor

Week 2 Assignment: Journal

Due Monday by 1:59am Points 35 Submitting a file upload

Submit Assignment

Required Resources Read/review the following resources for this activity:

Instructions Remember – these journal questions require more thinking than writing. Think about exactly what you are asked to do, and then write as economically as possible.

For this journal assignment, answer each of the following prompts:

Textbook: Chapter 4, 5 Lesson

Important Idea

Critical Thinking

Beliefs

Considering only the Introduction to Chapter 5, in terms of developing critical thinking and reasoning, what do you consider is the most valuable and important idea in that section? You can either summarize or directly quote the text; then, briefly explain why you find this idea important and valuable.

In Chapter 5, the section “Making Arguments” states: “In some ways applying our core critical thinking skills to analysis can be more difficult than offering an evaluative opinion. Analysis, like interpretation, is understanding at a deep level (p. 89)”

What concepts discussed in Chapter 4 might make analysis of a statement difficult – and why?

Why do you believe what you believe? What is your “evidence”? Test one of your beliefs by asking yourself, “Why?” As you answer each “why,” go down

7/16/20, 2:12 PM Page 1 of 5

Link: Example of Layers of Why

Suppose your claim is “All people should work to support their children.” Here is an example of possible “layers of why” for this claim:

Note

Don’t be tempted to skip steps. If you start with layer 5, you have just opened up a whole new line of “whys.” For example, why should everyone be afforded an opportunity to reach his or her highest potential? After all, for most of the history of the world, that has not been the case.

another layer – four layers will probably give you a good idea of why you believe what you believe. Your product should show a well-reasoned and logical basis for your belief. Stay away from the big stuff, like believing in God, or who to vote for in the next election, and don’t look for sources – this is about what you believe and why you believe it. After all, this is only an 8-week course, and we can’t settle everything! Click on the following link for an example of layers of why:

Layer 1: People should work to support their children because it is the right thing to do. Layer 2: It is the right thing to do because it is true that children need to be cared for by adults. Layer 3: I believe my last statement is true because it is an accurate description of what occurs – that is, very small children sicken and die if adults do not care for their needs; older children may exhibit many physical and emotional deficiencies if they are not properly cared for. Layer 4: Reasonable attention to the needs of children is just since children are largely dependent on their parents (who, after all, brought them into the world) for all of their needs during the early years of their lives. Furthermore, such attention leads to a healthy, productive and ordered society in which each individual has an opportunity to achieve his or her highest potential.

7/16/20, 2:12 PM Page 2 of 5

Journal Grading Rubric – 35 pts

Criteria Ratings Pts

5.0 pts

If you include references to outside sources (beyond the textbook), make sure you cite them properly.

Writing Requirements (APA format)

Grading This activity will be graded using the Journal Grading Rubric.

Course Outcomes (CO): 1, 4, 6

Due Date: By 11:59 p.m. MT on Sunday

Length: 2 pages (not including title page or references page) 1-inch margins Double spaced 12-point Times New Roman font Title page References page (as needed)

Length 5.0 pts Meets length requirement

0.0 pts Does not meet length requirement

Content Reflection

15.0 pts Reflection demonstrates a high degree of critical thinking in applying, analyzing, and evaluating key course concepts and theories from

12.75 pts Reflection demonstrates some degree of critical thinking in applying, analyzing, and/or evaluating key course concepts and theories from

11.25 pts Reflection demonstrates limited critical thinking in applying, analyzing, and/or evaluating key course concepts and theories from

9.0 pts Reflection lacks critical thinking. Superficial connections are made with key course concepts and course materials, activities,

0.0 pts Little or no reflection; copies or repeats text or lecture.

Top

7/16/20, 2:12 PM Page 3 of 5

15.0 pts

10.0 pts

readings, lectures, media, discussions activities, and/or assignments. Insightful and relevant connections made through contextual explanations, inferences, and examples.

readings, lectures, media, discussions activities, and/or assignments. Connections made through explanations, inferences, and/or examples.

readings, lectures, media, discussions, activities, and/or assignments. Minimal connections made through explanations, inferences, and/or examples.

and/or assignments.

Personal Growth

10.0 pts Conveys strong evidence of reflection on own work with a personal response to the self- assessment questions posed. Demonstrates significant personal growth and awareness of deeper meaning through inferences made, examples,

8.5 pts Conveys evidence of reflection on own work with a personal response to the self- assessment questions posed. Demonstrates satisfactory personal growth and awareness through some inferences made, examples, insights, and challenges. Some

7.5 pts Conveys limited evidence of reflection on own work in response to the self- assessment questions posed. Demonstrates less than adequate personal growth and awareness through few or simplistic inferences made, examples, insights, and/or

6.0 pts Conveys inadequate evidence of reflection on own work in response to the self- assessment questions posed. Personal growth and awareness are not evident and/or demonstrates a neutral experience with negligible personal impact.

0.0 pts No evidence of reflection.

7/16/20, 2:12 PM Page 4 of 5

Total Points: 35.0

5.0 pts

well developed insights, and substantial depth in perceptions and challenges. Synthesizes current experience into future implications.

thought of the future implications of current experience.

challenges that are not well developed. Minimal thought of the future implications of current experience.

Lacks enough inferences, examples, personal insights and challenges, and/or future implications are overlooked.

Writing Quality

5.0 pts Well written and clearly organized using standard English, characterized by elements of a strong writing style and basically free from grammar, punctuation, usage, and spelling errors.

4.25 pts Above average writing style and logically organized using standard English with minor errors in grammar, punctuation, usage, and spelling.

3.75 pts Average and/or casual writing style that is sometimes unclear and/or with some errors in grammar, punctuation, usage, and spelling.

3.0 pts Poor writing style lacking in standard English, clarity, language used, and/or frequent errors in grammar, punctuation, usage, and spelling. Needs work.

0.0 pts Lacks coherence; errors in grammar, usage and spelling interfere with readability and understanding to significant degree.

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Describe an example of one of these groups in the United States|2025

February 15, 2025/in Nursing Questions /by Besttutor

Describe an example of one of these groups in the United States or from another country. Explain why the population is designated as “vulnerable.

3 DQ 1

Vulnerable groups are people who are at high risk for poor health status and healthcare access, who undergo significant disparities in life expectancy and have limited access to healthcare services. This population is also likely to have 1 or more physical and/or mental health conditions.

According to WHO, vulnerable populations include; the uninsured, pregnant women, pediatric groups, malnourished people, children, the homeless, people with HIV/AIDS, racial and ethnic minorities, economically disadvantaged, and people with chronic health conditions.

An example of one of these groups in the United States or from another country.

In the US, older adults are more vulnerable to health issues

Explain why the population is designated as “vulnerable.” Include the number of individuals belonging to this group and the specific challenges or issues involved.

Because they have low immunity and a lot of medical conditions. A study found that the elderly don’t frequently receive the care recommended for them, such as preventive care, and thus end up being vulnerable. The number of older adults who are aged 65 or older. is 14.5% (46.3 million) of the US population. The challenges they face include isolation in their homes, failure to afford healthcare services, and difficulties while getting access to healthcare services.

Discuss why these populations are unable to advocate for themselves, the ethical issues that must be considered when working with these groups, and how nursing advocacy would be beneficial.

The elderly are unable to advocate for themselves because they are old, they can be easily controlled and economically unstable, and thus nobody minds about them even if they serve as their own advocates.
The ethical issues include; protecting their rights and human dignity, providing care with possible risk to their own health, informed consent, staffing patterns that limit their access to nursing care, and the use of physical restraints.
Nursing advocacy would help our aging population to save themselves a lot of time, money, as well as help in minimizing stress levels. They place an emphasis on the patient’s health and general well-being and therefore improving their health condition.
Using 200-300 words APA format with references to support the discussion.

Include the number of individuals belonging to this group and the specific challenges or issues involved. Discuss why these populations are unable to advocate for themselves, the ethical issues that must be considered when working with these groups, and how nursing advocacy would be beneficial.

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Informatics paper to be brushed up|2025

February 15, 2025/in Nursing Questions /by Besttutor

Textbook attached.

Redo paper so turnitin score is less than 20 %

Assignment:

The Future of Healthcare Informatics

Write an essay addressing each of the following points/questions. Be sure to completely answer all the questions for each number item. There should be three sections, one for each item number below, as well the introduction (heading is the title of the essay) and conclusion paragraphs. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least three (3) citations in your essay. Make sure to reference the citations using the APA writing style for the essay. The cover page and reference page do not count towards the minimum word amount. Review the rubric criteria for this assignment.

Identify the current role of the informatics nurse and predict the future role of the informatics nurse, based on scholarly sources.
Explain what is meant by connected health. Provide three examples of connected health in today’s healthcare environment. Explain the benefits and drawbacks of each.
In what ways has informatics impacted public health – please provide at least three examples.

Assignment Expectations:

Length: 500 words per essay prompt/section (1500 total for this assignment)

Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment. All APA Papers should include an introduction and conclusion.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as a Microsoft Word document (.doc or .docx) or a PDF document (.pdf)

File name: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.docx”)

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I HUMAN case study|2025

February 15, 2025/in Nursing Questions /by Besttutor

Assignment: i-Human Case Study: Evaluating and Managing Cardiovascular Conditions

Because cardiovascular conditions are preventable and manageable, it is important that the advanced practice nurse use both their understanding of the cardiovascular system and the impact of patient factors and behaviors that might increase patient risk of such conditions. This critical information can guide you in immediately identifying signs and symptoms that can inform differential diagnoses and lead to identification of appropriate treatment options and a treatment plan.

Photo Credit: yodiyim – stock.adobe.com

For this Case Study Assignment, you will analyze an i-Human simulation case study about an adult patient with a cardiovascular condition. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient.

To prepare:

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with cardiovascular conditions.
Access i-Human from this week’s Learning Resources and review this week’s i-Human case study Fred O. MacIntyre V5 PC. Based on the provided patient information, think about the health history you would need to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.
Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with cardiovascular conditions.

Assignment

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Patients Case Player Student Manual in the Week 1 Learning Resources.

By Day 7

Complete and submit your Assignment in i-Human.

Submission and Grading Information

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CONFLICT RESOLUTION PAPER|2025

February 15, 2025/in Nursing Questions /by Besttutor

Points

This assignment is worth 200 points.

Directions

1. Read Finkelman (2016), Chapter 13: Improving Teamwork: Collaboration, Coordination, and Conflict Resolution, section on Negotiation and Conflict Resolution, pp. 324-333.

2. Observe nurses in a care delivery setting. Identify a recurring conflict with the potential to negatively impact patient care. Decide if delegation was an issue in the conflict. This should be from your practice setting or prelicensure experiences.

3. Provide details of what happened, including who was involved, what was said, where it occurred, and what was the outcome that led you to decide the conflict was unresolved.

4. Identify the type of conflict. Explain your rationale for selecting this type.

5. Outline the four stages of conflict, as described in our text, and how they relate to your example.

6. Propose strategies to resolve the conflict. Search scholarly sources in the library and the Internet for evidence on what may be effective.

7. Discuss if delegation was an issue in the conflict. Be specific.

8. Describe how you would collaborate with a nurse leader to reach consensus on the best strategy to employ to deal with the conflict.

9. Describe the rationale for selecting the best strategy.

10. Provide a summary or conclusion about this experience or assignment and how you may deal with conflict more effectively in the future.

1. Follow APA format. Consult your APA manual, and consider using the APA resources provided by Chamberlain.

2. Write a 5-7 page paper (not including the title or References pages) using APA format that includes the following.

a. Describe an unresolved (recurring) conflict that you experienced or observed. Identify the type of conflict.

b. Provide details of what happened, including who was involved, what was said, where it occurred, and what was the outcome that led you to decide the conflict was unresolved.

c. Outline the four stages of conflict, as described in Finkelman, and how the stages relate to your example. Decide if delegation was an issue in the conflict. Be specific.

d. Describe the strategies for conflict resolution and how you would collaborate with a nurse leader to resolve the conflict. Cites the course textbook and two scholarly sources.

e. Provide a conclusion or summary about this experience and how you may deal with conflict more effectively in the future.

f. Submit by the end of Week 3.

Read Finkelman (2016), Chapter 13: Improving Teamwork: Collaboration, Coordination, and Conflict Resolution, section on Negotiation and Conflict Resolution, pp. 324-333.

BELOW

There are three types of conflict: individual, interpersonal, and intergroup/organizational ( MindTools®, 2014a ).

· Individual conflict. The most common type of individual conflict in the workplace is role conflict, which occurs when there is incompatibility between one or more role expectations. When staff do not understand the roles of other staff, this can be very stressful for the individual and affects work. Staff may be critical of each other for not doing some work activity when in reality it is not part of the role and responsibilities of that staff member, or staff members may feel that another staff member is doing some activity that really is not his or her responsibility.

· Interpersonal conflict. This conflict occurs between people. Sometimes this is due to differences and/or personalities; competition; or concern about territory, control, or loss.

· Intergroup/organizational conflict. Conflict also occurs between teams (e.g., units, services, teams, healthcare professional groups, agencies, community and a healthcare provider organization, and so on). Sometimes this is due to competition, lack of understanding of purpose for another team, and lack of leadership within a team or across teams within an HCO.

Gets Results

A leader’s ultimate purpose is to accomplish organizational results. A leader gets results by providing guidance and managing resources, as well as performing the other leader competencies. This competency is focused on consistent and ethical task accomplishment through supervising, managing, monitoring, and controlling of the work.

Prioritizes, organizes, and coordinates taskings for teams or other organizational structures/groups

· Uses planning to ensure each course of action achieves the desired outcome.

· Organizes groups and teams to accomplish work.

· Plans to ensure that all tasks can be executed in the time available and that tasks depending on other tasks are executed in the correct sequence.

· Limits overspecification and micromanagement.

Identifies and accounts for individual and group capabilities and commitment to task

· Considers duty positions, capabilities, and developmental needs when assigning tasks.

· Conducts initial assessments when beginning a new task or assuming a new position.

Designates, clarifies, and deconflicts roles

· Establishes and employs procedures for monitoring, coordinating, and regulating subordinates’ actions and activities.

· Mediates peer conflicts and disagreements.

Identifies, contends for, allocates, and manages resources

· Allocates adequate time for task completion.

· Keeps track of people and equipment.

· Allocates time to prepare and conduct rehearsals.

· Continually seeks improvement in operating efficiency, resource conservation, and fiscal responsibility.

· Attracts, recognizes, and retains talent.

Removes work barriers

· Protects organization from unnecessary taskings and distractions.

· Recognizes and resolves scheduling conflicts.

· Overcomes other obstacles preventing full attention to accomplishing the mission.

Recognizes and rewards good performance

· Recognizes individual and team accomplishments; rewards them appropriately.

· Credits subordinates for good performance.

· Builds on successes.

· Explores new reward systems and understands individual reward motivations.

Seeks, recognizes, and takes advantage of opportunities to improve performance

· Asks incisive questions.

· Anticipates needs for action.

· Analyzes activities to determine how desired end states are achieved or affected.

· Acts to improve the organization’s collective performance.

· Envisions ways to improve.

· Recommends best methods for accomplishing tasks.

· Leverages information and communication technology to improve individual and group effectiveness.

· Encourages staff to use creativity to solve problems.

Makes feedback part of work processes

· Gives and seeks accurate and timely feedback.

· Uses feedback to modify duties, tasks, procedures, requirements, and goals when appropriate.

· Uses assessment techniques and evaluation tools (such as AARs) to identify lessons learned and facilitate consistent improvement.

· Determines the appropriate setting and timing for feedback.

Executes plans to accomplish the mission

· Schedules activities to meet all commitments in critical performance areas.

· Notifies peers and subordinates in advance when their support is required.

· Keeps track of task assignments and suspenses.

· Adjusts assignments, if necessary.

· Attends to details.

Identifies and adjusts to external influences on the mission or taskings and organization

· Gathers and analyzes relevant information about changing situations.

· Determines causes, effects, and contributing factors of problems.

· Considers contingencies and their consequences.

· Makes necessary, on-the-spot adjustments.

Figure 13-1 Competency: Gets results and associated components and actions

Source: U.S. Army. (2006). Army leadership: Competent, confident, and agile. Retrieved from http://fas.org/irp/doddir/army/fm6-22.pdf

When conflict occurs, something is out of sync, usually due to a lack of clear understanding of one another’s roles and responsibilities. Sometimes conflict is open and obvious, and sometimes it is not as obvious; this latter type may be more destructive as staff may be responding negatively without a clear reason. Everyone has experienced covert conflict. It never feels good and increases stress quickly. Distrust and confusion about the best response are also experienced. Acknowledging covert conflict is not easy, and staff will have different perceptions of the conflict since it is not clear and below the surface. Overt conflict is obvious, at least to most people, and thus coping with it is usually easier. It is easier to arrive at an agreement when overt conflict is present and easier to arrive at a description of the conflict.

The common assumption about conflict is that it is destructive, and it certainly can be. There is, however, another view of conflict. It can be used to improve if changes are made to address problems related to the conflict. The following quote speaks to the need to recognize that conflict can be viewed as an opportunity.

When I speak of celebrating conflict, others often look at me as if I have just stepped over the credibility line. As nurses, we have been socialized to avoid conflict. Our modus operandi has been to smooth over at all costs, particularly if the dynamic involves individuals representing roles that have significant power differences in the organization. Be advised that well-functioning transdisciplinary teams will encounter conflict-laden situations. It is inevitable. The role of the leader is to use conflicting perspectives to highlight and hone the rich diversity that is present within the team. Conflict also provides opportunities for individuals to present divergent yet equally valid views that allow all team members to gain an understanding of their contributions to the process. Respect for each team member’s standpoint comes only after the team has explored fully and learned to appreciate the diversity of its membership.

( Weaver, 2001 , p. 83)

This is a positive view of conflict, which on the surface may appear negative. If one asked nurses if they wanted to experience conflict, they would say no. Probably behind their response is the fact that they do not know how to handle conflict and feel uncomfortable with it. However, if you asked staff, “Would you like to work in an environment where staff at all levels could be direct without concern of repercussions and could actively dialogue about issues and problems without others taking comments personally?” many staff would most likely see this as positive and not conflict. Avoidance of conflict, however, usually means that it will catch up with the person again, and then it may be more difficult to resolve. There may then be more emotions attached to it, making it more difficult to resolve.

Causes of Conflict

Effective resolution of conflict requires an understanding of the cause of the conflict; however, some conflicts may have more than one cause. It is easy to jump to conclusions without doing a thorough assessment. Some of the typical causes of conflict between individuals and between teams/groups are “whether resources are shared equitably; insufficient explanation of expectations, leading to performance being questioned; unexplained changes that disturb routines and processes and that team members are not prepared for; and stress resulting from changes that team members do not understand and may see as threatening” ( Finkelman & Kenner, 2016 , p. 336).

Two predictors of conflict are the existence of competition for resources and inadequate communication. It is rare that a major change on a unit or in an HCO does not result in competition for resources (staff, financial, space, supplies), so conflicts arise between units or between those who may or may not receive the resources or may lose resources. Causes of conflict can be varied. An understanding of a conflict requires as thorough an assessment as possible. Along with the assessment, it is important to understand the stages of conflict.

Stages of Conflict

There are four stages of conflict that help describe the process of conflict development ( MBA, 2014 ):

1. Latent conflict. This stage involves the anticipation of conflict. Competition for resources or inadequate communication can be predictors of conflict. Anticipating conflict can increase tension. This is when staff may verbalize, “We know this is going to be a problem,” or may feel this internally. The anticipation of conflict can occur between units that

Figure 13-2 Stages of conflict

accept one another’s patients when one unit does not think that the staff members on the other unit are very competent yet must accept orders and patient plans from them.

2. Perceived conflict. This stage requires recognition or awareness that conflict exists at a particular time. It may not be discussed but only felt. Perception is very important as it can affect whether or not there really is a conflict, what is known about the conflict, and how it might be resolved.

3. Felt conflict. This occurs when individuals begin to have feelings about the conflict such as anxiety or anger. Staff feel stress at this time. If avoidance is used at this time, it may prevent the conflict from moving to the next stage. Avoidance may be appropriate in some circumstances, but sometimes it just covers over the conflict and does not resolve it. In this case the conflict may come up again and be more complicated. Trust plays a role here. How much do staff trust that the situation will be resolved effectively? How comfortable do staff members feel in being open with their feelings and opinions?

4. Manifest conflict. This is overt conflict. At this time the conflict can be constructive or destructive. Examples of destructive behavior related to the conflict are ignoring a policy, denying a problem, avoiding a staff member, and discussing staff in public with negative comments. Examples of constructive responses to the conflict include encouraging the team to identify and solve the problem, expressing appropriate feelings, and offering to help out a staff member. ( Figure 13-2 highlights the stages of conflict.)

Prevention of Conflict

Some conflict can be prevented, so it is important to take preventive steps whenever possible to correct a problem before it develops into a conflict. A staff team or HCO that says it has no conflicts is either not aware of conflict or prefers not to acknowledge it. Prevention of conflict should focus on the typical causes of conflict that have been identified in this chapter. Clear communication, known expectations, appropriate allocation of resources, and delineation of roles and responsibilities will go a long way toward preventing conflict. If the goal is to eliminate all conflict, this will not be successful because it cannot be done.

Since not all conflict can be prevented, managers and staff need to know how to manage conflict and resolve it when it exists. It is important to identify potential barriers that can make it more likely that a situation will turn into a conflict or will act as barriers to conflict resolution. First and foremost, if all staff make an effort to decrease their tension or stress level, this will go a long way in preventing or resolving conflict. In addition to this strategy, it is important to improve communication, recognize team members as members with expertise, listen and compromise to get to the most effective decision given the available data, understand the roles and responsibilities of team/staff members, and be willing to evaluate practice and team functioning.

Conflict Management: Issues and Strategies

Conflict management is critical in any HCO. When conflicts arise, then managers and staff need to understand conflict management issues and strategies. The major goals of conflict management are as follows:

1. To eliminate or decrease the conflict

2. To meet the needs of the patient, family/significant others, and the organization

3. To ensure that all parties feel positive about the resolution so future work together can be productive

Powerlessness and Empowerment

When staff experience conflict, powerlessness and empowerment, as well as aggressiveness and passive-aggressiveness, become important. When staff members feel that they are not recognized, appreciated, or paid attention to, then they feel powerless. What happens in a work environment when staff feel powerless? First, staff members do not feel they can make an impact; they are unable to change situations they think need to be changed. Staff members will not be as creative in approaching problems. They may feel they are responsible for tasks yet have no control or power to effect change with these tasks. The team community will be affected negatively, and eventually the team may feel it cannot make change happen. Staff may make any of the following comments: “Don’t bother trying to make a difference,” “I can’t make a difference here,” and “Who listens to us?” Morale deteriorates as staff feel more and more powerless. New staff will soon pick up on the feeling of powerlessness. In some respects, the powerlessness really does diminish any effort for change. As was discussed in Chapter 3 , responding to change effectively is very important today. In addition, when staff feel powerless, this greatly impacts the organizational culture.

Power is about influencing decisions, controlling resources, and affecting behavior. It is the ability to get things done—access resources and information, and use them to make decisions. Power can be used constructively or destructively. The power a person has originates from the person’s personal qualities and characteristics, as well as the person’s position. Some people have qualities that make others turn to them—people trust them, consider their advice helpful, and so on. A person’s position, such as a team leader or nurse manager, has associated power.

Power is not stagnant. It changes as it is affected by the situation. There are a number of sources of power. Each one can be useful depending on the circumstances and the goal. An individual may have several sources of power. The common sources of power include the following:

· Legitimate power. This power is what one typically thinks of in relation to power. It is power that comes from having a formal position in an organization such as a nurse manager, team leader, or vice president of patient services. These positions give the person who holds the position the right to influence staff and expect staff to follow requests. Staff members recognize that they have tasks to accomplish and job requirements. It is important to note that a leader must have legitimate power. This is a critical concept to understand about leadership and power. However, it takes more than power to be an effective leader and manager. The leader must also demonstrate competency.

· Reward power. A person’s power comes from the ability to reward others when they comply. Examples of reward power include money (such as an increase in salary level), desired schedule or assignment, providing a space to work, and recognition of accomplishment.

· Coercive power. This type of power is based on punishment initiated when a person does not do what is expected or directed. Examples of punishment may include denial of a pay raise, termination, and poor schedule or assignment. This type of power leads to an unpleasant work situation. Staff will not respond positively to coercive power, and this type of power has a strong negative effect on staff morale.

· Referent power. This informal power comes from others recognizing that an individual has special qualities and is admired. This person then has influence over others because they want to follow the person due to the person’s charisma. Staff feel valued and accepted.

· Expert power. When a person has expertise in a particular topic or activity, the person can have power over others who respect the expertise. When this type of power is present, the expert is able to provide sound advice and direction.

Box 13-3 Types of Power

· Legitimate

· Reward

· Coercive

· Referent

· Expert

· Informational

· Persuasive

· Informational power. This type of power arises from the ability to access and share information, which is critical in the Information Age.

· Persuasive power. This type of power influences others by providing an effective point of view or argument ( Finkelman & Kenner, 2016 ). ( Box 13-3 highlights the types of power.)

All HCOs experience their own politics, and this usually involves some staff trying to gain power, hold on to power, or expand power. As has been said, power can be used negatively, and this can also lead to the unethical use of power or not doing the right thing with the power. Chapter 2 discusses examples of ethical issues. There is no doubt that there are managers who use their power to control staff, as well as staff who use power to control other staff, but this is not a healthy use of power. Rather, it is a misuse of power and does not demonstrate nursing leadership.

A self-appraisal of a person’s personal view of power allows the individual to better understand how the person uses power and how it then affects the person’s decisions and relationships. This can lead to more effective responses to change during planning and decision making, coping with conflict, and the ability to collaborate and coordinate.

Empowerment is often viewed as the sharing of power; however, it is more than this. “To empower is to enable to act” ( Finkelman & Kenner, 2016 ). Power must be more than words; it must be demonstrated. Participative decision making empowers staff but only if staff really do have the opportunity to participate and influence decisions. Recognizing that one’s participation is accepted makes a difference. True empowerment gives the staff the right to choose how to address issues with the manager.

Should all staff be empowered? A critical issue to consider when answering this question is whether or not staff can effectively handle decision making. This implies that staff members need leadership qualities and skills to make sound decisions and participate together collaboratively. They need to be able to use communication effectively. When staff members are selected, all these factors become important. Empowerment is not gained just by being a member of the staff, but rather staff members become empowered because they are able to handle it. Management who want to empower staff must transfer power over to the staff, but management must first feel confident that staff can handle empowerment.

When staff are empowered, some limits or boundaries need to be set, or conflict may develop. Some of these boundaries are established by the HCO’s policies, procedures, and position descriptions; education and experience; standards; and laws and regulations (for example, state nurse practice acts). The manager must be aware of these boundaries and establish any others that may be required (for example, direct involvement of staff in the selection process for new equipment). If staff members are involved in the decision making, then they should first be given a list of several possible equipment choices that meet the budgetary requirements and criteria to use in the evaluation process. It is critical that the manager make clear the boundaries, or staff members will feel like their efforts are useless if their suggestions are rejected because they were not given the boundaries. Setting staff up by not giving them full information leads to poor choices and is not effective. What does this mean? Roles and responsibilities need to be clearly described, and if they change, they need to be discussed. At the same time, the nurse manager or the team leader must not control, domineer, or overpower staff. This type of response is usually seen in new nurse managers or team leaders who feel insecure. Ineffective use of empowerment can be just as problematic as a lack of empowerment.

Although empowering oneself may seem like an unusual concept, it is an important one. The amount of power a person has in a relationship is determined by the degree to which someone else needs what the other person has. Anger is related to expectations that are not met, and when these expectations are not met, the person may act out to gain power. It is the responsibility of the nursing profession to communicate what nurses have to offer to patient care and to the healthcare delivery system, but individual nurses also need to understand what they have to offer as nurses. To have an impact, this communication and development must be ongoing. Empowerment can be positive if the strategies that are used to gain empowerment are constructive (for example, gaining new competencies, speaking out constructively, networking, using political advocacy, increasing involvement in planning and decision making, getting more nurses on key organization committees, improving image through a positive image campaign, and developing and implementing assertiveness). There are many other strategies that can result in empowerment that improves the workplace and the nurse’s self-perception.

Aggressive and Passive-Aggressive Behavior

Aggressive and passive-aggressive behavior can interfere with successful conflict resolution and might even be the cause of conflict. When staff members are hostile to one another, the team leader, or the nurse manager, anxiety rises. Hostile behavior can be a response to conflict. It is important to recognize personal feelings. The first response should be to get emotions under control and communicate control to the hostile staff member. The nurse manager or team leader may be the one who is hostile, which makes it even more complex and requires assistance from higher-level management. It is hoped someone will recognize the need to bring the situation under control and try to move to a private place. Demonstrations of open conflict with hostility should not take place in patient or public areas. If the suggestion to move to a private area does not work and the situation continues to escalate, simply walking away may help set some boundaries. Cool down time is definitely needed.

There are many times when more information is really required before a response can be given. If this is the case, everyone concerned needs to be told that when information is gathered, the issue or problem will then be discussed. No one should be pressured to respond with inadequate information as this will lead to ineffective decision making and may lead to further hostility. It is critical that after further assessment is completed there be additional discussion and a conclusion.

When there are conflicts with patients and families, what is the best way to cope? Many of the same strategies mentioned earlier can be used. Safety is the first issue, as it must be maintained. It is never appropriate to allow patients or families to demonstrate anger inappropriately. When this occurs, someone needs to set reasonable limits that are based on an assessment of the situation. There may be many reasons for anger and inappropriate behavior, such as pain, medications, fear and anxiety, psychosis, dysfunctional communication, and so on. Staff need to avoid taking things personally as this will interfere with thoughtful problem solving. When one gets defensive or emotional, interventions taken to resolve a conflict may not be effective. Active listening is critical to cope with emotions. If a different culture is involved, then this factor needs to be considered. (For example, some cultures consider it appropriate to be very emotional, and others do not.) In the long term, clear communication is critical during the entire process.

How Do Individual Staff Members Cope With Conflict?

Not everyone responds to conflict in the same way, and individuals may vary in how they respond dependent on the circumstances. Four typical responses to conflict are avoidance, accommodation, competition, and collaboration ( MindTools®, 2014a ).

· Avoidance occurs when a person is very uncomfortable and cannot cope with the anxiety effectively. This person will withdraw from the situation to avoid it. There are times when this may be the most effective response, particularly when the situation may lead to negative results, but in many situations this will not be effective in the long term. This response might occur when a staff member is in conflict with a manager and disagrees with the manager. The staff member must consider whether it is worthwhile to disagree publicly. Typically avoidance occurs when one side is perceived as more powerful than the other. It is a helpful approach when more information is needed or when the issue is not worth what might be lost.

· A second response is accommodation. How does this occur? The person tries to make the situation better by cooperating. The critical issue may not be resolved or not resolved to the fullest satisfaction. The goal is just to eliminate the conflict as quickly as possible. Accommodation works best when one person or team is less interested in the issue than the other. It can be advantageous as it does develop harmony, and it can provide power in future conflict since one party was more willing to let the conflict deflate. Later interaction may require that the other party cooperate.

· A third response is competition. How does this work? Power is used to stop the conflict. A manager might say, “This is the way it will be.” This closes further efforts from others who may be in conflict with the manager.

· Collaboration is the fourth response, which has been discussed in this chapter. This is a positive approach, with all parties attempting to reach an acceptable solution, and in the end, both sides feel they won something. Collaboration often involves some compromise, which is a method used to respond to conflict.

Using the best conflict resolution style can make a difference in success. There are many ways that a conflict can be resolved. When conflict occurs, each person involved has a personal perspective of the issue and conflict. Today there is more conflict in the healthcare delivery environment with increased workplace stress that may lead to misunderstandings, ineffective communication, and reduced productivity and dysfunctional organizations, as noted in the Institute of Medicine reports ( 2001 , 2004 ).

Gender Issues

Are there differences in the ways in which women and men negotiate? There are differences in how women and men approach leadership issues such as conflict ( Greenberg, 2005 ). Men tend to negotiate to win, while women focus more on what is fair. It is believed that this is related to the way children play through sports and activities. Women will make an effort to reach win-win solutions. Men will test the limits that have been set more overtly than women, so it is important for women to ensure that limits are set and maintained. It is important, despite the differences described, to avoid stereotyping.

Nurse-Physician Relationships

Though the nurse-physician relationship should be the strongest relationship that nurses have to meet the needs of the patient, it frequently is not. Both sides have a role in the inadequacies of this relationship. Conflict does occur and this conflict can act as a barrier to effective patient care. Collegial relationships are those where there is equality of power and knowledge. In contrast, collaborative relationships between nurses and physicians focus on mutual power, but typically the physician’s power is greater. The nurse’s power is based on the nurse’s extended time with patients, experience, and knowledge. In addition to power, this relationship requires respect and trust between the nurse and physician. Due to these factors, it is a complex relationship.

Nurses have long worked on teams, mostly with other nursing staff. However, the nurse-physician relationships have become more important in the changing healthcare environment with the greater emphasis on interprofessional teams. Nurse-physician interactions and communication have been discussed for a long time in healthcare literature.

Physicians, however, are not the only healthcare providers nurses must work with while they provide care. (For example, nurses work with other nursing staff, social workers, support staff, laboratory technicians, physical therapists, pharmacists, and many others.) There are also other members joining the healthcare team such as alternative therapists (massage therapists, herbal therapists, acupuncturists, etc.), case managers, more actively involved insurers, and so forth. The future will probably bring other new members into the healthcare delivery system. Nurses need to develop the skills necessary to participate effectively on the team, which requires collaboration, communication, coordination, delegation, and negotiation. Communication and delegation are discussed in other chapters. It is difficult to practice today in any healthcare setting without experiencing interprofessional interactions such as nurse to physician. Effective teams:

· work together (collaborate).

· recognize strengths and limitations.

· respect individual responsibilities.

· maintain open communication.

Positive professional communication is critical. Both sides should initiate positive dialogue rather than adversarial positions. Cooperation and collaboration are also integral to the success of this relationship. A frequent question discussed in the literature is “Why is there conflict between nurses and physicians?” The structure of work is different for physicians and for nurses, and this has an impact on understanding, communicating, collaborating, and coordinating. This perspective identifies the key elements as sense of time, sense of resources, unit of analysis, sense of mastery, and type of rewards as described by the following:

· The nurse is focused on shorter periods of time, and time is usually short, with frequent interruptions. The physician’s sense of time focuses on the course of illness.

· If a physician gives a stat order, the physician has problems understanding what might interfere with the nurse’s making this a priority. There is a lack of understanding of the nurse’s work structure.

· Physicians often are not concerned with resources, though this is certainly changing as physicians recognize that there may be a shortage of staff as well as issues about costs and reimbursement for care. They, however, may not be willing to accept these factors as relevant when their patients need something. There are, of course, other resources such as equipment availability, supplies, and funds that can cause problems and conflicts. Nurses are typically more aware of the effect that these factors have on daily care and the work that needs to be done.

· Unit of analysis is another factor; for example, nurses are caring for groups of patients even though care is supposed to be individualized. Physicians may not have an understanding of this if they have only a few patients in the hospital.

· Physicians also do not have an understanding of nursing delivery models, and often nurses themselves are not clear about them. This affects nurses’ ability to explain how they work.

· The sense of reward is different. Nurses work in a task-oriented environment and typically get paid an hourly rate. Most physicians are not salaried and are independent practitioners, though some are employees of the organization (hospital, clinic, and so on).

Conflict and verbal abuse are related. Verbal abuse occurs in healthcare settings between patients and staff, nurses and other nurses, physicians and nurses, and all other staff relationships. This abuse can consist of statements made directly to a staff member or about a staff member to others. A common complaint from nurses regards verbal abuse from physicians. In addition to impacting quality care, verbal abuse affects turnover rates and contributes to the nursing shortage, so it is has serious consequences.

How can this problem be improved? A critical step is to gain better understanding of each profession’s viewpoint and demonstrate less automatic acceptance of inappropriate behavior. This requires that management become proactive in eliminating negative communication and behavior. Some hospitals have tried a number of strategies to deal with verbal abuse. The IOM recommends increased interprofessional approaches to care delivery and the need for increased

Case Study A Verbal Explosion Leads to Confrontation of a Problem

As a nurse manager in a busy operating room (OR), you have to ensure that all staff are collaborating and communicating well. In the past six months, you have noticed more problems with poor communication between nurses and physicians, which had an impact on the quality of care. Nurses are also frequently complaining that they are “second-class citizens” in the department. The number of last-minute call-ins has increased by 25% over the past six months, causing staffing problems. Today was the last straw when a nurse and a surgical resident had a shouting match in the hallway. The nurse left the encounter crying, and the resident said he would not work with the nurse anymore. The nurse manager went into the OR medical director’s office. They have had a positive collaborative relationship over several years. She went in and said, “We have a problem!” As she described the problems, he said, “I was unaware there was so much tension and lack of collaboration. Why didn’t you tell me this earlier?”

Questions:

1. How would you respond to the medical director’s question?

2. What do you and the medical director need to do?

3. How can you avoid this being a we/they situation?

4. How will you involve all staff?

5. What can you do about the powerlessness the nurses feel?

interprofessional education among health professions so all health professions are prepared to work together on teams ( 2003a ). What can nurses do about this? One suggestion is to improve their knowledge base and thus develop more self-confidence. Another problem is that nurses think they must resolve all problems and “make things” work correctly when this may not be realistic. The nurses then become scapegoats. Verbal abuse, no matter who—physician or nurse—is doing it, should not be tolerated. Those involved need to be approached in private to identify the need for a change in behavior. Staff needs to be respected. The AONE Guiding Principles for Excellence in Nurse-Physician Relationships is found in Box 13-4 .

Application of Negotiation to Conflict Resolution

Negotiation is the critical element in making conflict a nightmare or an opportunity. Negotiation can be used to resolve a conflict, and some types of negotiation, such as mediation, can be very structured. When two or more people or organizations disagree or have opposing views about a problem or solution, a conflict exists. To resolve the conflict, the involved people need to discuss resolution in a manner that is acceptable to all involved. Although it does not have to take long, in some cases it may be very long, such as what might occur in a union-employer negotiation for a contract. Conflict resolution includes the use of a variety of skills and strategies. As the process begins, it is important to clarify all of the issues and parties who are involved in the conflict. Performance or potential outcomes should be established early in the process. Questioning is important throughout resolution. For example, it is important to ask about behaviors that started the conflict and how to avoid them in the future. Management needs to be clear about expectations and provide these in writing, which helps to decrease conflict over critical issues. Since conflict is inevitable, all staff nurses will encounter it. Knowing how to manage conflict will be of great benefit to the individual nurse as well as improve the working environment and ability to better reach patient outcomes.

Patients should not become part of staff or organizational conflicts, and there is risk that this may occur. Consider these examples:

· The interprofessional team cannot agree on a treatment approach and must do this by the end of the team meeting.

· A patient’s insurer refuses to allow the patient to stay two more days in the hospital. As the hospital’s nurse case manager, you must work with the insurer representative to reach a compromise.

· Staffing in a hospital has been reduced, and the nurses are convinced that the new staffing level will be unsafe for patients. Something must be done to resolve this issue.

· A home healthcare agency learned that the Medicare contract has changed and specific patients will receive fewer visits.

How can these examples be resolved satisfactorily so the quality of care does not suffer and staff still work together collaboratively? Finding a mentor to discuss the process as well as vent feelings may be helpful. Developing negotiation skills makes conflicts easier to handle and less stressful. Nurses who become involved in unions will find that negotiation skills are also very important. If negotiation is not used effectively, all of these conflict examples can lead to major problems for the patient and/or staff.

When approaching conflict resolution, it is important to recognize that both sides contributed to the conflict. One side cannot have a conflict by itself; it takes at least two. Consider how each side has contributed to the conflict. Another critical issue is to carefully consider if this is the time and place to address the conflict. When the environment is too emotional, conflict resolution will be difficult. Stepping back or taking a break may be the best position to take. The following are strategies that can be used to negotiate effectively ( MindTools®, 2014b ):

· Negotiate for agreements—not winning or losing. Clearly state that your desire is to find a solution and to work together.

· Separate people from positions.

· Establish mutual trust and respect.

· Avoid one-sided or personal gains.

· Allow time for expressing the interests of each side/party.

· Listen actively during the process, and acknowledge what is being said; avoid defending or explaining yourself.

Box 13-4 Aone Guiding Principles for Excellence in Nurse-Physician Relationships

Introduction to the Guiding Principles

Excellent working relationships between nurses and physicians are key to creating a productive, safe, and satisfying practice environment. The patient and the patient’s family benefit from care delivered by a team practicing within this environment.

Senior leadership in healthcare organizations must support the development of excellent relationships and, more importantly, create an environment that sustains and nurtures these critical relationships.

Guiding Principles for Excellence in Nurse-Physician Relationships

Institutions that are committed to establishing and maintaining environments that promote excellence in the nurse/physician relationship adhere to the following principles.

1. Interdisciplinary collaborative relationships are promoted, nurtured and sustained.

2. This requires that practitioners be proficient in communication skills, leadership skills, problem solving, conflict management, utilizing their emotional intelligence, and functioning within a team culture.

3. Excellence in relationship building begins with hiring, continues with learning and developing together and is reinforced over time.

4. The organization has specific systems for reward, recognition, and celebration.

5. The organization supports the “Platinum Rule” with a specific Professional Code of Conduct that includes a system to support it. A “No Tolerance” standard exists for those unable to adhere to the Code.

6. The organization creates and supports a “Just & Fair” environment.

7. The work of all professional caregivers is seen as interdependent and collegial.

8. Cross-discipline job discovery is supported and encouraged.

9. Patient-focused care and better patient outcomes are the organizing force behind creating a collaborative environment.

Implementation Guidelines

Interdisciplinary collaborative relationships are promoted, nurtured and sustained.

10. Nurses and physicians are given formal training in communication skills, leadership development, problem solving, conflict management, development of emotional intelligence, and team functions. Education and training is provided to nurse/physician teams and is not discipline specific.

11. Specific education is provided in team building.

12. Organization governing bodies and committees have representative members from all disciplines.

13. Nurse/physicians leadership teams are identified to lead the work at the unit level. (Microsystem Management)

14. All organizational task forces include representatives from those stakeholders closest to the issue.

15. Interdisciplinary collaborative relationships are assessed, unit-by-unit. Each unit has a development and improvement plan for continued growth of the relationship.

16. Teams develop common values for their interdisciplinary collaboration.

17. Teams develop common language for their interdisciplinary collaboration.

18. Nurse/physician collaborative champions are identified at the hospital and unit level.

Excellence in relationship building begins with hiring, continues with learning and developing together and is reinforced over time together and is reinforced over time.

19. Nurses and physicians work collaboratively to identify the behaviors that they want in team members.

20. Employees, both nurse and physician, are hired using behavioral interviewing to ascertain a good fit with the organization, teams, values, culture, and behavioral expectations.

21. Nurses and physicians do 360 degree performance reviews.

22. Credentialing criteria includes behavioral attributes and expectations, as well as clinical skills.

23. The Graduate Medical Education competencies are used as hiring criteria and for performance review.

24. Education and team training is done in work teams, as described in the Institute of Medicine reports.

25. Personal accountability for demonstrating team behaviors is rewarded.

The organization has specific systems for reward, recognition, and celebration.

26. There is alignment of purpose among the disciplines regarding reward/recognition & celebration.

27. Mechanisms for reward and recognition are easy to access.

28. Performance appraisal is linked to patient satisfaction measurements.

29. Awards, recognition and celebration are public and visible and across disciplines and teams—Example: Physicians identify the Nurse of the Year; Nurses identify the Physician of the Year.

30. Rewards and Recognition programs promote team accomplishments.

The organization supports the “Platinum Rule” with a specific Professional Code of Conduct that includes a system to support it. A “No Tolerance” standard exists for those unable to adhere to the Code.

31. The Golden Rule states: “Do unto others as you would have them do unto you.” The Platinum Rule states: “Do unto others as they would have you do for /unto them.” Thus, this principle speaks to treating others as they want to be treated, not necessarily how you would want to be treated.

32. Code of Conduct Guidelines/Policies exists for all professionals that outline behavioral expectations.

33. Work improvement plans and measures hold the team accountable, not just individual.

34. Individual professional codes of ethics/conduct are known and honored.

35. Contacts and processes/procedures for the impaired professional are easily accessible to all staff.

36. There are identified coaches and mentors for the professionals on site in the hospital to help with performance issues.

37. All professionals receive team training that focuses on communication skills and processes.

38. Processes exist to identify and address conflict situations before they become a crisis and/or deteriorate.

The organization creates and supports a “Just & Fair” environment.

39. There is a systems approach to management and decision-making.

40. Internal trends and reporting processes are multidisciplinary.

41. Language for reporting and safety is analyzed to assure that it is “Just & Fair”.

42. Processes exist for multidisciplinary critical incident debriefing.

43. Decision-making tools are used that support the “Just & Fair” processes, such as the “Just Model”.

44. The processes outlined in the patient-safety literature that creates cultures of safety are used as blue prints for culture changes.

45. Remedial training is offered when needed.

The work of all professional caregivers is seen as interdependent and collegial.

46. The culture of team includes all disciplines providing care on a unit.

47. Behavioral expectations are defined for all disciplines.

Cross-discipline job discovery is supported and encouraged.

48. All disciplines are educated in the role/responsibility of their colleagues.

49. Opportunities for shadowing different professions are encouraged.

Patient-focused care and better patient outcomes are the organizing force behind creating a collaborative environment.

50. Work is directed toward identifying and measuring those outcomes that are sensitive to the function of collaboration.

51. Patients and families are appointed to internal committees.

52. Patient-centeredness is a key focus for processes.

Source: From AONE Guiding Principles For Excellence In Nurse–Physician Relationships. Copyright © 2005 by American Organization of Nurse Executives. Used by permission of American Organization of Nurse Executives.

· Use data/evidence to strengthen your position.

· Focus on patient care interests.

· Always remember that the process is a problem-solving one, and the benefit is for the patient and family.

· Clearly identify the priority and arrive at common goal(s).

· Avoid using pressure.

· Identify and understand the real reasons underlying the problem.

· Be knowledgeable about organizational policies, procedures, systems, standards, and the law, applying this knowledge as needed.

· Try to understand the other side, and ask questions and seek clarification when unsure or uncertain; understanding the other side first before explaining yours increases effectiveness.

· Avoid emotional outbursts and overreacting if the other party exhibits such behavior; depersonalize the conflict.

· Avoid premature judgments, blame, and inflammatory comments.

· Be concrete and flexible when presenting your position.

· Be reasonable and fair.

There are some conflicts that require a third-party negotiator to reach a more effective resolution. This is needed when there is no opportunity for cooperative problem solving and objectivity is required. “Mediation is an informal and confidential way for people to resolve disputes with the help of a neutral mediator who is trained to help people discuss their differences. The mediator does not decide who is right or wrong or issue a decision. Instead, the mediator helps the parties work out their own solutions to problems” ( U.S. Equal Employment Opportunity Commission, 2014 ). Mediators are facilitators, not decision makers (as in the case of arbitrators). In mediation, the people with the dispute have an opportunity to tell their story and to be understood, as well as to listen to and understand the story of the other party. A key factor in mediation is the need for all parties to willingly participate in the process. The mediator guides the process and discussion. Certain guidelines are established for the discussion that all parties must follow throughout the process (for example, allowing each party time to speak and complete a statement without interruption, calling for a break when needed, enforcing time-limited meetings, substantiating comments with facts, and so on). With these guidelines and the presence of a mediator, this type of negotiation can result in positive outcomes. It provides protection for both sides.

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PSYCHOPHARMACOLOGY|2025

February 15, 2025/in Nursing Questions /by Besttutor

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.

Case: An elderly widow who just lost her spouse.

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:

• Metformin 500mg BID

• Januvia 100mg daily

• Losartan 100mg daily

• HCTZ 25mg daily

• Sertraline 100mg daily

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86

By Day 3 of Week 7

Post a response to each of the following:

• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

Respond to the these discussions. All questions need to be addressed.

Discussion 2 Me

Treatment of a Patient with Insomnia

The case presented this week, is that of a 75-year-old widow who just lost her spouse 10-months ago. Th patient presents with chief complaints of insomnia. Past medical history of DM, HTN, and MDD is reported. Since the passing of her husband, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: Metformin 500mg BID, Januvia 100mg daily, Losartan 100mg daily, HCTZ 25mg daily, and Sertraline 100mg daily. Current weight: 88 kg. Current height: 64 inches. Temp: 98.6 degrees F. BP: 132/86 (Walden University).

Question number one, what brings you in today? By asking an open-ended question, the patient is more willing to share information with the provider (Stern, 2016). Another question that would be of beneficial knowledge during the interview is, do you consume caffeine? If so, how much caffeine do you consume in a day? Caffeine consumption close to bedtime contributes greatly to insomnia (Farazdaq et al., 2018). Lastly, the third question that should be asked is, do you suffer from Gastro Esophageal Reflux Disease (GERD). According to Farazdaq, Andrades, and Nanji, (2018) GERD is a contributing factor to insomnia in elderly patients. By asking the above questions, the provider can rule out environmental factors while assessing the patients concerns with open-ended questions.

People in the patient’s life that could provide further information is children or caretakers. Questions that would be appropriate to ask the patient’s children or caretaker would be if there is a recent decrease in her appetite, energy, mood, or interests. By asking about these areas of the patient’s life will provide external information that the patient might be withholding or may be unaware of.

Insomnia relies heavily on self-report for a diagnosis (Levenson et al., 2015). Also, a physical exam could be performed with the order of blood testing to rule out thyroid problems. According to Dr. Abhinav Singh (2021), hyperthyroidism results in nervousness from overactivity of this hormone, and insomnia is often a symptom. Administering the Hamilton Anxiety Rating Scale (HAM-A) would assess the severity of the patient’s anxiety. The HAM-A results would aid with further treatment of the patient’s insomnia, if related to anxiety (Psychiatry & Behavioral Health Learning Network, 2021). Another appropriate scale to administer to this patient is the Hamilton Depression Rating Scale (HDRS). HDRS is an assessment that focuses on feelings of guilt, mood, suicidal ideation, activities, weight, various stages of insomnia, and many more important areas (Hamilton, 1960).

The patient presents with a previous diagnosis of depression. The differential diagnosis for this patient is Generalized Anxiety Disorder (GAD), secondary to husband’s death. There are many possible changes within the living dynamics, such as financial burdens, fear of her own death, and suddenly sleeping alone. Changes within this patient’s routine may be a cause of reported insomnia.

Temazepam is FDA approved for insomnia, and used off-label for anxiety disorders, acute mania, psychosis, and catatonia (Puzantian & Carlat, 2020). Temazepam is generally effective in the treatment of insomnia, by enhancing widespread inhibitory activity of GABA (Levenson et al., 2015). Temazepam is metabolized through the liver without CYP450 (Puzantian & Carlat, 2020). Another good sleep aid choice is Trazodone. Trazodone is widely used for insomnia (Levenson et al., 2015). Trazodone is FDA approved for the treatment of major depression and used off-label for insomnia and anxiety (Puzantian & Carlat, 2020). Trazodone inhibits serotonin reuptake, alpha-1 adrenergic receptor antagonist, and serotonin 5-HT2A and 5-HT2C receptor antagonist (Puzantian & Carlat, 2020). And Trazodone is metabolized primarily through CYP3A4 to active metabolite mCPP, that is metabolized by 2D6, inducing P-glycoprotein (Puzantian & Carlat, 2020). Trazodone, however, carries the side effect of daytime somnolence and dizziness (Puzantian & Carlat, 2020).

The favorable medication for this patient, is Temazepam. Temazepam is a safer medication to use in elderly patients because of the lack of active metabolites, its short half-life and absence of drug interactions (Puzantian & Carlat, 2020). The patient is currently taking Metformin, Januvia, Losartan, HCTZ, and Sertraline. Based on the current medications, the patient is being treated for diabetes mellitus, hypertension, and depression. Adding Temazepam to the patient’s medication regimen would not result in toxicity of other medications. Sleep is heritable and regulated by numerous genes. A genome wide association study found numerous single-nucleotide polymorphisms (SNPs) significantly associated with insomnia symptoms. The most significant SNPs occurred within genes involved in neuroplasticity, stress reactivity neuronal excitability, and mental health (Rajib, 2020).

The starting dose of Temazepam is lower in the elderly population (Puzantian & Carlat, 2020). The proper dose to begin with this patient, is Temazepam 7.5mg tab PO QHS. At the 4-week checkup, the expected outcome would be an increased ability to sleep, and reduced anxiety. If these results have not been achieved, Temazepam 15mg tab PO Q HS would be ordered. Temazepam does have the risk of weakness and dizziness, so great care and caution would need to be taken when increasing the dose. There needs to be an evaluation of the effects at week 8, or sooner if needed. The maximum dose of Temazepam is 30mg PO Q HS, and even lower in the elderly (Puzantian & Carlat, 2020).

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