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NR 511 Week 4 Midterm Exam Version 5

February 26, 2025/in Nursing Questions /by Besttutor

NR 511 Week 4 Midterm Exam Version 5

Question 1: How often should the clinician examine the feet of a person with diabetes?

a. Once a year
b. Every 6 months
c. Every 3 months
d. Every visit

Question 2: Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis?

a. Cholinesterase inhibitors
b. Anxiolytics
c. Antidepressants
d. Atypical antipsychotics

Question 3: Most adult poisonings are:

a. intentional and self-inflicted.
b. accidental.
c. caused by someone wishing to do harm to the person.
d. not attributed to any reason.

Question 4: A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?

a. “It is probably just a cyst, because that is the most common breast mass.”
b. “We will order a mammogram and ultrasound to help establish a diagnosis.”
c. “We will go ahead and schedule you for a biopsy because that is the only way to know for sure.”
d. “Because your lump is painful, it is most likely not cancer.”

Question 5: Which of the following is a specific test for multiple sclerosis (MS)?

a. Magnetic resonance imaging (MRI)
b. Computed tomography (CT) scan
c. A lumbar puncture
d. There is no specific test.

Question 6: After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?

a. Suggest she use a heating pad to improve circulation
b. Refer to a podiatrist for a foot care treatment plan
c. Send her for acupuncture treatments
d. All of the above

Question 7: Which characteristic of delirium helps to distinguish delirium from dementia?

a. Abrupt onset
b. Impaired attention
c. Affective changes
d. Delusions

Question 8: Which clinical feature is the first to be affected in increased intracranial pressure (ICP)?

a. Decrease in level of consciousness (LOC)
b. Headache
c. Nausea
d. Widening pulse pressure

Question 9: Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited range of motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?

a. Posterior dislocations are more common than anterior dislocations.
b. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses.
c. Recurrent dislocations are uncommon and would require a greater force to result in injury.
d. Surgery is most commonly the treatment of choice.

Question 10: Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?

a. Decreased C-reactive protein
b. Hyperalbuminemia
c. Morning stiffness
d. Weight gain

Question 11: The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?

a. Overweight

b. Mild obesity

c. Moderate obesity
d. Morbid obesity

Question 12: The vegetarian patient with gout asks the clinician about food that he should avoid. The clinician should advise the patient to avoid which of the following foods?

a. Rice
b. Carrots
c. Spinach
d. Potatoes

Question 13: A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her exam?

a. Human papillomavirus (HPV)
b. Endometrial hyperplasia
c. Vagismus
d. Polycystic ovarian syndrome

Question 14: Which of the following classes of drugs should be used as first-line therapy for treatment of delirium?

a. Benzodiazepines
b. Antipsychotics
c. Anticonvulsants
d. Antidepressants

Question 15: What is the treatment of choice for a patient diagnosed with testicular cancer?

a. Radical orchidectomy

b. Lumpectomy

c. Radiation implants
d. All of the above

Question 16: A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease (STD) has she most probably been exposed to?

a. Gonorrhea
b. Human papillomavirus (HPV)
c. Chlamydia
d. Trichomonas

Question 17: A 58-year-old woman who had a total abdominal hysterectomy at the age of 45 is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment?

a. Conjugated estrogen 0.625 mg/day oral
b. Estradiol 7.5 mcg/24 hr vaginal ring
c. Medroxyprogesterone 10 mg/day oral
d. Conjugated estrogen 0.3 mg + medroxyprogesterone 1.5 mg/day oral

Question 18: When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are?

a. Spores

b. Leukocytes

c. Pseudohyphae
d. Epithelial cells

Question 19: Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point?

a. 10%

b. 20%

c. 30%
d. 50%

Question 20: John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?

a. Valgus stress test
b. McMurray circumduction test
c. Lachman test
d. Varus stress test

Question 21: During a digital rectal exam (DRE) on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

a. An enlarged rubbery gland

b. A hard irregular gland

c. A tender gland
d. A boggy gland

Question 22: Janet is a 30-year-old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?

a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks

Question 23: The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (text revision) (DSM-IV-TR) state that excessive worry or apprehension must be present more days than not for at least:

a. 1 month.
b. 3 months.
c. 6 months.
d. 12 months.

Question 24: A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram (ECG) changes should the clinician expect as a manifestation of the disease?

a. Sinus bradycardia

b. Atrial fibrillation

c. Supraventricular tachycardia
d. U waves

Question 25: Which type of burn injury results in destruction of epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?

a. Superficial burns
b. Superficial partial-thickness burns
c. Deep partial-thickness burns
d. Full-thickness burns

Question 26: Immunizations are an example of which type of prevention?

a. Primary
b. Secondary
c. Tertiary

Question 27: If a previously frostbitten area becomes frostbitten again after it has healed, what might occur?

a. Permanent tissue damage may occur, resulting in necrosis to that body part.
b. The area will be super sensitive.
c. The area is prone to a repeat frostbite.
d. The area is as susceptible as any other area.

Question 28: A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?

a. Pregnancy test

b. Pelvic ultrasound

c. Endometrial biopsy
d. Platelet count

Question 29: Julie, aged 50, has migraine headaches, frequent asthma attacks, coronary artery disease, and hypertension. Which of the following prophylactic medications would you order for her migraines?

a. Propranolol

c. Ergotamine
b. Timolol

d. Topiramate

Question 30: A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment?

a. Tricyclic antidepressants
b. Capsacin cream
c. Vitamin B12 injections
d. Insulin

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Case Study

February 26, 2025/in Nursing Questions /by Besttutor

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5kg.
  2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
  3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
  5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)
  5. Inhaled short-acting bronchodilator (ProAir HFA)
  6. Inhaled corticosteroid (Flovent HFA)
  7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

  1. Describe the clinical manifestations present in Mrs. J.
  2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
  3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
  4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
  5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
  6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
  7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

PLEASE FOLLOW RUBRICS

Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived  Evaluation of appropriateness of nursing interventions at the time of admission is thoroughly discussed. A well-supported explanation for each of the medications listed is presented. Strong and compelling rationale is provided. signs and symptoms.

Four cardiovascular conditions that may lead to heart failure are clearly described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. Overall, the discussion demonstrates insight into medical and nursing interventions used to prevent heart failure.

Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. The discussion fulfills the assignment criteria and strong rationale for the interventions is provided.

A well-developed health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are clearly discussed. An strong explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. The overall discussion is well-supported.

A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is thoroughly described. The method is clearly appropriate for the client and prevents readmission. Strong rationale is provided for support.

All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.

All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.

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

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

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Advance Practice

February 26, 2025/in Nursing Questions /by Besttutor

Apply information from the Aquifer Case Study to answer the following discussion questions:

•Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).

•Describe the physical exam and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not?

•What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?

Do Two pages.

Provide References.

See attached Aquifer Case Study.

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Lifestyle Changes for Weight Loss

February 26, 2025/in Nursing Questions /by Besttutor

Sally is a 43-year-old mother of two who has gained 50 pounds over the past five years. She is 64 inches tall and weighs 180 pounds with a BMI of 30.8. Her waist circumference is 37 inches. She acknowledges that she is not as physically active as she would like to be. She also notes how recent stresses in her life have affected her sleep and seem to have triggered her appetite for sweets. Sally’s father recently died from complications of type 2 diabetes and her mother and sisters are overweight. Sally says she is very motivated to “not get diabetes” and is disturbed that her recent physical exam revealed mildly elevated blood pressure, glucose, and cholesterol levels.

 

1.   How does Sally’s family history influence her weight and risk for diabetes? What lifestyle choices may influence her genetic predisposition to be overweight?

 

2.   Using information in this chapter, what is a reasonable goal weight for Sally? How long would you estimate it would take her to safely lose this amount of weight?

 

3.   What weight-loss strategies may help curb Sally’s stress-related eating?

 

4.   Sally has determined that—to lose weight—she needs to limit her daily caloric intake to 1400 kcalories. Use Table 9-2 and show a one-day plan for meals and snacks that meet her nutritional needs within this calorie level.

 

5.   What are some advantages to Sally keeping a food and exercise record? What other factors besides food intake and physical activity may be useful for Sally to record?

 

6.   Why might strength training be an important addition to Sally’s exercise regimen?

 

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Dietary Analysis Project

February 26, 2025/in Nursing Questions /by Besttutor

Part I: 24-hour Food & Beverage Recall with Predictions

 

Use this template in conjunction with the Complete Dietary Analysis Project Instructions. Submit this template when finished with each Part (there are Parts I, II and III included).

 

Personal information of person interviewed (please include all):

Gender: Female

Height: 5’5

Weight: 222

Age: 42

Activity level: none

 

Date/Day of the Week (add rows if needed & divide by meals/snacks):

Time Food/Condiment/Beverage How Much Ate/Drank

(use cups or ounces, tablespoons)

9:12 am Oatmeal, regular, cooked (no salt or fat added) 1 cup
9:12 am Bacon, pork cooked 3 medium slices
9:12 am water 16 ounces
1:32pm Salad, grilled chicken, bacon, cheese, lettuce, tomato, carrots, no dressing 1 ½ cup
7:25 pm Pizza, with meat and vegetables, thick crust 1 pizza (5″ across pizza) 5” across pizza
7:25pm Salad, Caesar, with dressing

 

1 cup
7:25 pm water 16.9 ounces
8:00pm wine 3.5 ounces
     
     
     
     
     
     
     

Predictions (2 parts):

 

Part 1: Original charts with your predictions

  Total Calories Dietary Fiber Food Groups Macronutrients Micronutrients
      Veg Fruit Whole Grains Dairy Protein Carbs Fat Vitamins/ Minerals
Low x     x   x x     x
Adequate   x     x     x x  
High     x              

 

  Sodium Saturated fat Cholesterol
Low   x x
Moderate x    
High      

 

 

 

Part 2:

Write at least five sentences explaining why you are predicting what you predict for each category . Please address the micronutrients in general (if you think overall the 24-hour recall diet will be too low, adequate/moderate or too high in most vitamins and minerals) and also specifically address the mineral, sodium and the sub-categories, saturated fat, cholesterol and dietary fiber in your write-up . You will lose points for not addressing all categories noted here.

 

NUTR 100 – Dietary Analysis Project Template

Part II: Data Findings and Analysis of Original 24-hour Food Recall

 

Data Findings & Analysis

 

Getting Started:

Please submit this Template for Part II, which should include your completed Part I above and any corrections needed per the instructors feedback. Also, be sure to submit the Nutrient Intake Report.

Use this template in conjunction with the Complete Dietary Analysis Project Instructions. Submit this template when finished with each Part.

 

· Start with the Daily Food Group Targets. Click on “View by Meal” (located under the graph on the Food Tracker page). You will want to copy and paste the Food Groups table into this document, replacing the example below. You may not be able to simply copy and paste depending on your computer. You can also take a screenshot, and then crop the graphic as needed (see example below).

 

Food Group Table

 

 

· Next, look at the Daily Food Group Graph (next to the word data and below the daily food group targets). Take a screenshot, and then crop the graphic as needed (see example below); then answer the questions and write a summary of your findings per the instructions below.

 

 

 

 

Food Group Graph

 

 

Food Group Questions:

· What are the total percentages of the target for each food group?

· Example: Grains are 94%, Vegetables are 151%, Fruits are 111%, Dairy is 53% and Protein is 71% of the targets.

· For grains, what percent is whole and what percent is refined (hover the arrow over the sections on the chart and it will show this)?

· Example: Whole grains are 65% of total grains

· For dairy, what percent is from milk/yogurt and what percent is from cheese?

· Example: Milk and yogurt are 80% of dairy intake; cheese is 20% of dairy intake

· For fruit, what percent is from whole fruit and what percent is from fruit juice?

· Whole fruit is 60% of fruit intake and fruit juice is 40% of fruit intake.

· Write at least five sentences addressing your findings regarding the food groups for the diet recall. Address, what foods from the 24-hour diet recall caused the food groups to be in these proportions? How can they be improved upon for the revised diet?

 

· Next, look at Daily Limits. This is below the graph you were just looking over on SuperTracker.

 

As with the above graphs, these charts need to be used in the final presentation, so save them now (sometimes right clicking and selecting “save picture as” will work). You may copy and paste into this template, you may use screenshots (replace the example below).

 

Daily Limits Graph

 

 

Daily Limits Questions: (please answer them all together in paragraph form)

· Write at least five sentences summarizing your findings for daily limits. Address, what foods from the 24-hour diet recall caused these levels of daily limits? How can they be improved upon for the revised diet? Include answers to the questions below as well.

· What are total calories eaten for the day? Are they within 100 calories of the total limit? If not, how can this be achieved with the revised menu?

· Should added sugar be reduced in order to be lower than the limit? If yes, how can you revise the menu to meet this target while meeting other targets?

· How much saturated fat, and sodium were eaten and what were those limits? If these are above the limits how can they be improved upon in the revised menu?

 

 

The next step is to open the Nutrient Intake Report (just below the graph, smaller print, next to “Related Links”). You will need to submit this report with your Part II submission as well as with the final presentation, so make sure to save it! I strongly recommend exporting it as a word document so you can edit it per the requirements for Part III. The report will list the target (or RDA), average eaten, and the status. Make note of those that exceed guidelines and those that do not meet the guidelines. For now, you can assess this as over or under the guideline just based on the status provided. In your final presentation submission you will be converting these to percentages. Remember that for saturated fat, cholesterol and sodium you want to be below the value, so no need to comment if you fall below, only if you exceed it.

 

You now have all the information you need to assess the data and write up your findings. Keep this information, as you will need it for the final presentation of your work.

 

Outcomes of Your Predictions

See if your predictions matched up with the findings. Include both charts below with your original predictions and findings.

 

Original Charts with Your Predictions:

  Total Calories Fiber Food Groups Macronutrients Micronutrients
      Veg Fruit Whole Grains Dairy Protein Carbs Fat Vitamins/ Minerals
Too Low                    
Adequate                    
Too High                    

 

  Sodium Saturated fat Cholesterol
Low      
Moderate      
High      

 

 

Analysis Charts with Your Findings:

  Total Calories Fiber Food Groups Macronutrients Micronutrients
      Veg Fruit Whole Grains Dairy Protein Carbs Fat Vitamins/ Minerals
Too Low                    
Adequate                    
Too High                    

 

  Sodium Saturated fat Cholesterol
Low      
Moderate      
High      

 

 

Outcomes of your predictions summary:

(Write at least 5 sentences discussing and comparing your predictions with the findings. Please summarize which of your predictions were accurate (or close) and which were not. For those predictions that were not in line with the findings discuss why you think your predictions were off)

 

NUTR 100 – Dietary Analysis Project Template

Part III: Original 24-hour Food Recall with Revised 24-hour Final Menu & Analysis

Getting Started:

Please use the provided Template for Parts I, II & III, which should include your completed Part I & II and any corrections needed per the instructors feedback. Label all graphs and tables as “Revised” so it’s easy for me to distinguish between the original menu data and the revised menu data. IMPORTANT: before starting Part III take a look at the check list of requirements for the revised menu at the end of this document.

 

Date/Day of the Week (add rows if needed):

ORIGINAL 24-hour recall REVISED 24-hour menu
Time Original: Food/Condiment/Beverage How Much Ate/Drank

(use cups or ounces, tablespoons)

Time Food/Condiments/Beverages Amount
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           

(Revised) Daily Food Group Targets (insert screen shot using revised 24-hour menu you created)

Location Note: the two charts below can be generated using SuperTracker, located under the Daily Food Group Targets, select “View By Meal”, they are the last two charts on the screen.

 

Macintosh HD:Users:erikapied:Desktop:Screen Shot 2016-06-21 at 7.43.34 PM.png

 

 

 

 

 

 

 

 

 

(Revised) Daily Food Group Graph (insert screen shot using revised 24-hour menu you created)

 

 

 

(Revised) Daily Limits (insert screen shot using revised 24-hour menu you created)

Fill in the following “Master Comparison Table” to help you address and compare the following areas:

 

  Target (per SuperTracker) Original 24-hour recall Menu Revised 24-hour Menu
Total Calories      
Whole Grains At least 50%    
Added Sugars Limit:    
Saturated Fat Limit:    
Sodium Limit: 2300 mg    
Cholesterol <300 mg    
Dietary Fiber >25 g    

 

 

Revised Menu Questions: (please include at least 8 sentences addressing these questions)

· Based on your findings what were the areas (food groups, nutrients etc.) that needed revising from the original menu?

· Were you successful at improving these areas? If so, how did you improve these areas in the revised menu? If not, why not?

· What were your challenges with revising the menu?

· How did you overcome them?

 

 

Checklist of Requirements for Revised Menu:

To be considered a correct, revised menu, the following should be met: (Use this as a checklist before submitting; part of your grade will be showing you can meet these targets)

 

· Total calories should be within 100 calories from the target calories. For example, if the target calories are 1800 calories, then your revised menu have calories totaling between 1700-1900 calories.

· Daily Food Groups Report: Should read OK; it is acceptable to go over, as long as total calories are +/- 100 calories for the day and there is balance between the overages (for example, 110% grains, 110% dairy, 120% vegetables versus 110% fruit, 350% protein, 200% dairy).

· Graph (Food Group bar graph): Should be at 100% (+/-10%) for all targets, acceptable to go over as long as total calories are +/- 100 calories for the day and there is balance between the overages (for example, 110% grains, 110% dairy, 120% vegetables versus 110% fruit, 350% protein, 200% dairy).

· For grains, at least 50% should be whole grains. Fruit juice should not be in excess.

· Daily Limit: Should be within +/- 100 calories of the target. Added sugar, saturated fat, cholesterol and sodium should not exceed their limits.

· Nutrient Intake Report: There are more nutrients than we are looking at listed on this report, so only focus on the nutrients we covered extensively in class (calories, protein grams and %, carbohydrate grams and %, total fat and %, saturated fat, cholesterol, dietary fiber and all vitamins and minerals listed). There are a few extra that we did not cover as extensively in class, so please do not worry about discussing those (they are: monounsaturated fat, polyunsaturated fat, linoleic acid, alpha-linolenic acid, omega-3 EPA and omega 3-DHA).

· ***IMPORTANT*** Highlight total calories if the average eaten is +/- 100 calories of the target, if the number is outside of the range, write “Less than 100 calories below” or “Greater than 100 calories above.”

· All macronutrients (carbs, protein and total fat) % Calories should be within the AMDR target range listed under Target. Any macronutrient outside of the AMDR should be highlighted and indicated as “Over” or “Under.”

· Dietary Fiber should be at least 25 grams, anything less should be highlighted and labeled as “Under”.

· For Saturated fat , anything over 10 percent should be highlighted and indicated as “Over.”

· For Cholesterol , anything over 300 mg should be highlighted and indicated as “Over.”

· For Sodium , anything over 2400 mg should be highlighted and indicated as “Over.”

· For micronutrients (vitamins and minerals), calculate the % of the target for each and enter it in the status column. To do this, divide the actual intake by the target and multiple by 100. Type this percentage in to the Word version of the report next to the status (for example, OK 105%). This will make it easier for you to make comments on this for the final presentation. Highlight any that are less than 80% or greater than 200% of the target. It may say OK, but we still want to be careful not to go too far over each day. Only highlight those when greater than 200% or less than 80% along with their calculated percentage.

 

Please note: If the person you are creating a menu for has very high calorie needs (2800 calories or more), you will likely need to exceed 200% for many of the vitamins and minerals because you will need a larger amount of total food to meet the calorie needs. Just make sure that the macronutrients are still within the AMDR, even at the higher calorie level. If you have a menu where the calorie needs are 2800 or more you will be graded based on 300% instead of 200% for the high end of the range.

 

 

 

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advanced pharmacology

February 26, 2025/in Nursing Questions /by Besttutor

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

· Synthroid 100 mcg daily

· Nifedipine 30 mg daily

· Prednisone 10 mg daily

 

There are many causes of nausea and vomiting, most commonly these symptoms are caused by ingestion of substances or drugs, gastrointestinal disorders or metabolic disorders (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). In this particular case study it is important to take into consideration the factors that could be contributing to the nausea, vomiting and diarrhea in patient HL. The patient has a history of drug abuse. With that being said, drug withdraw can be a factor in the cause of nausea, vomiting and diarrhea. Treatment for this type of cause would be dependent on what type of drug that patient was withdrawing from. The next factor would be medications the patient is currently taking. All three of these medications have nausea and vomiting as potential side effects. If this is the cause of the patient’s chief complaint, changing the medications could be an appropriate response. The last consideration would be the patient’s diagnosis of possible Hepatitis C. The most common symptoms of Hepatitis C include nausea, vomiting, and diarrhea (Franciscus, 2015). It would be hard to diagnosis the cause of this episode of nausea vomiting without other information such as aggravating and relieving factors, how long these symptoms have been occurring and if any other symptoms are associated with these. First line treatment of nausea and vomiting include phenothiazines such as promethazine. Promethazine can be given in 12.5-25mgs every four to six hours as needed. Contraindications include hypersensitivity, seizure disorders and Parkinson’s disease. Adverse effects include sedation, agitation, dry mouth and blurred vision (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).  Second line therapy would be to add an antihistamine or anticholinergic such as diphenhydramine. This medication is dosed from 25-50mg every six to eight hours as needed. Adverse effects include drowsiness, confusion and dry mouth. Contraindications include asthma, hypersensitivity and narrow-angle glaucoma (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). If this persists the patient needs to reevaluate for other causes. Alternative therapies including herbal therapies such as vitamin b6 , ginger and even gum chewing are linked to the relief of nausea and vomiting (Darvall, Handscombe & Leslie, n.d.).

 

References:

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. (2017). Pharmacotherapeutics for Advanced Practice (Vol. 4). Philadelphia: Wolters Kluwer.

Darvall, J. N., Handscombe, M., & Leslie, K. (n.d.). Chewing gum for the treatment of postoperative nausea and vomiting: a pilot randomized controlled trial. BRITISH JOURNAL OF ANAESTHESIA, 118(1), 83–89. https://doi-org.ezp.waldenulibrary.org/10.1093/bja/aew375

 

Franciscus, A. (2015). HCV Advcocate. Retrieved from HCSP Fact Sheet : http://hcvadvocate.org/hepatitis/factsheets_pdf/SEM_Nausea.pdf

 

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Discussion Board prompt 1

February 26, 2025/in Nursing Questions /by Besttutor

What is the difference between a protocol, standard of care delivery, and policy at the practice, state, and federal level? Briefly outline each. What are the perceptions of the health care delivery system from the perspectives of patients, providers, payers, and policy makers? Discuss at least one perception from one of the populations listed: patient, provider, payer, and policy maker.

 

Due date 08/22/2020

2 replies. References and APA

Bottom of Form

Reply 1 Ingrid

Protocols can be defined as an official procedures or system process’ implemented by a facility, institution, or government establishment. Standards of care delivery is defined as a diagnostic and/or treatment process that a health care provider or professional must adhere to base on a certain type of condition, condition, and/or circumstance. Policy is defined as course of action adopted by a business, corporation, hospital, and/or government establishment (Shiel, 2018).

At the practice level, protocols are what healthcare workers must perform as a guide to a management of a clinical situation and is incorporated into systems as a way healthcare professionals to provide the best evidenced-based care to their patients (n.d.). At the state level and federal level, professional expectations are established and provide the consistency to ensure quality of care. Nurses are expected to follow state and federal level regulations to protect the patient. If the standards of care according to state and federal levels are not met, legal implications can occur as the nurse can be found violating the standard of care. The legal implications can lead to malpractice on the health care professional (n.d.).

A perception that patients have regarding health care delivery system is that health care professionals are held to a standard and must be competent to perform their duties. Patients understand their condition with expectations regarding their treatments, if their treatments are not met, Patients know well enough to file complaints or legal action against the health care employee. From a provider perspective, health care professionals must attend proper schooling and complete a license exam. Having that license ensures that you are competent. The license can be revoked if you are unable to perform your duties therefore a health professional must be responsible and accountable for their actions.

 

Reply 2 Kristopher

Protocols are an agreed framework outlining the care that will be provided to patients in a designated area of practice. An example of this is a protocol to evaluate and discontinue unnecessary urinary catheters. This protocol has a set of guidelines that can be followed and carried out without a physicians order.

Standard of care delivery describes the care patients should be offered by health professionals and health services for a specific clinical condition or defined clinical pathway in line with current best evidence. (Clinical Care Standards, n.d.)

Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. An explicit health policy can achieve several things: it defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups; and it builds consensus and informs people. (Health policy, 2013)

Patient wants satisfactory health treatment, providers focus on patient safety, payers are responsible for enabling the process of patient access and policy makers have viewpoint to provide services, plan and manage health care policies.

Among all, patients’ perception needs to be discuss in detail here because insights of providers, payers and policy makers are concerned with them and their treatment. In a patient’s viewpoint, he or she is expecting, competent, compassionate and ethical care.

 

2 Board Discussion.

Due date 08/22/250250

APA, references.

 

Discussion Prompt 1

Describe how the educational level achieved by a nurse or the entry point into professional nursing practice affects the quality and competence of a nurse’s participation in policy making.Why it is important for registered nurses to influence the regulatory process? Does the nurses education have influence on their ability to make an impact?

Discussion Prompt 2

Reflect on what you have learned in this course. What were your major takeaways? Surprises? How will you apply what you have learned to your career?

 

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Stage of Change Algorithm (nutrition counseling)

February 26, 2025/in Nursing Questions /by Besttutor

Develop a Stage of Change Algorithm for a specific dietary behavior.  The purpose of the algorithm is to determine which stage of change (Transtheoretical Model) an individual is in.  Complete the algorithm with 2 people.

Submit the algorithm and a brief summary of your experience using it with other people.  Include the stage of change you identified for each of the 2 people.

Refer to the “Meeting your Client Ch 4 Lecture” under Modules for an example.

you have to follow similar 5 quistion ( the questions i uplod ) and do it for two patient

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Agenda Comparison Grid

February 26, 2025/in Nursing Questions /by Besttutor

NURS 6050N

Students will:

1. Compare U.S. presidential agenda priorities

Evaluate ways that administrative agencies help address healthcare issues

Analyze how healthcare issues get on administrative agendas

Identify champions or sponsors of healthcare issues

Create fact sheets for communicating with policymakers or legislators

Justify the role of the nurse in agenda setting for healthcare issues

 

2. Assignment: Agenda Comparison Grid and Fact Sheet or Talking Points Brief

It may seem to you that healthcare has been a national topic of debate among political leaders for as long as you can remember.

Healthcare has been a policy item and a topic of debate not only in recent times but as far back as the administration of the second U.S. president, John Adams. In 1798, Adams signed legislation requiring that 20 cents per month of a sailor’s paycheck be set aside for covering their medical bills. This represented the first major piece of U.S. healthcare legislation, and the topic of healthcare has been woven into presidential agendas and political debate ever since.

 

As a healthcare professional, you may be called upon to provide expertise, guidance and/or opinions on healthcare matters as they are debated for inclusion into new policy. You may also be involved in planning new organizational policy and responses to changes in legislation. For all of these reasons you should be prepared to speak to national healthcare issues making the news.

In this Assignment, you will analyze recent presidential healthcare agendas. You will also prepare a fact sheet to communicate the importance of a healthcare issue and the impact on this issue of recent or proposed policy.

 

 

 

To Prepare:

· Review the agenda priorities of the last three U.S. presidential administrations.

· Select an issue related to healthcare that was addressed by each of the last three U.S. presidential administrations.

· Reflect on the focus of their respective agendas, including the allocation of financial resources for addressing the healthcare issue you selected.

· Consider how you would communicate the importance of a healthcare issue to a legislator/policymaker or a member of their staff for inclusion on an agenda.

 

 

The Assignment: (2- to 3-page Comparison Grid and 1-page Fact Sheet)

Part 1: Agenda Comparison Grid

Based on the presidential administrations you are comparing, complete the Agenda Comparison Grid. Be sure to address the following:

· Identify and provide a brief description of the healthcare issue you selected.

· Identify which administrative agency would most likely be responsible for helping you address the healthcare issue you selected.

· How does the healthcare issue get on the agenda and how does it stay there?

· Who was the entrepreneur/champion/sponsor of the healthcare issue you selected?

 

Part 2: Fact Sheet or Talking Points Brief

Based on your Agenda Comparison Grid for the healthcare issue you selected, develop a 1-page Fact Sheet or Talking Points Brief that you could use to communicate with a policymaker/legislator or a member of their staff for this healthcare issue. Be sure to address the following:

· Summarize why this healthcare issue is important and should be included in the agenda for legislation.

· Justify the role of the nurse in agenda setting for healthcare issues.

 

 

 

 

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PICOT Statement Paper

February 26, 2025/in Nursing Questions /by Besttutor

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

  1. Evidence-Based Solution
  2. Nursing Intervention
  3. Patient Care
  4. Health Care Agency
  5. Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric.

Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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