Tag: Clinical-Nursing

Low-grade Cervical Dysplasia -cellular alteration & prognosis

A common finding with Papanicolaou tests (aka pap smear or pap test) is low-grade cervical dysplasia, most often occurring in the squamocolumnar junction, the area of the cervix where the squamous and columnar cells meet (Lim, Lee, Cho, Hong, Lim, 2016) Low-grade Cervical Dysplasia -cellular alteration & prognosis. Low-grade Cervical Dysplasia -cellular alteration & prognosis Alterations expected at the cellular level would show chaotic, non-uniform growth of cervical cells, as well as loss of organization of grouped cells (Hammer & McPhee, 2019) Low-grade Cervical Dysplasia -cellular alteration & prognosis.

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Low-grade cervical dysplasia, otherwise referred to as low-grade squamous epithelial lesions,  are most often attributed to human papillomavirus (HPV), with more than 90% of cases, regardless of etiology, spontaneously regressing (Tornesello, Buonaguro, Giorgi-Rossi, & Buonaguro, 2013). Specific high-risk serotypes of HPV have a more significant impact on cervical cells, increasing risk for malignancy if left untreated (Hammer & McPhee, 2019). With more than 100 strains, HPV is broken into “low risk” and “high risk” categories Low-grade Cervical Dysplasia -cellular alteration & prognosis. Low-grade Cervical Dysplasia -cellular alteration & prognosis The difference between the two seems to be how the HPV genome encodes oncoproteins, E6 and E7, and the level of expression of each (Hammer & McPhee, 2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis

For the best odds at the most favorable prognosis, options and suggested screenings should be discussed with S.V., with a personalized plan in alignment with her needs and preferences, considering her personal and familial health history Low-grade Cervical Dysplasia -cellular alteration & prognosis. Possible options could include an HPV screen to determine if this is a factor (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019). If HPV is present and deemed to be “low risk” to cervical health, a 6 month repeat pap smear (Behnamfar, Zafarbakhsh, & Allameh, 2015), an HPV screen, or a combination of both may be scheduled Low-grade Cervical Dysplasia -cellular alteration & prognosis (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019) Low-grade Cervical Dysplasia -cellular alteration & prognosis. With negative findings at that time, based on S.V.’s age of 35, screening could be resumed at the CDC recommendation of every three years for just a pap smear, or every 5 years for a negative primary HPV or negative co-testing (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis

References:

Behnamfar, F., Zafarbakhsh, A., & Allameh, T. (2015). Study of 2 years follow-up of referral patients with abnormal pap smear.
 Journal of Research in Medical Sciences, 20
(12) doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.4103/1735-1995.172981 Low-grade Cervical Dysplasia -cellular alteration & prognosis

Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (2019 August 20). 
Cervical Cancer: What should I know about screening?
 Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/cancer/cervical/basic_info/screening.htm

Hammer, G. & McPhee, S. (2019). 
Pathophysiology of disease: An introduction to clinical medicine
 (8th ed.). New York, NY: McGraw-Hill Education /Medical

Lim, S., Lee, M. J., Cho, I., Hong, R., & Lim, S. C. (2016). Efficacy of p16 and ki-67 immunostaining in the detection of squamous intraepithelial lesions in a high-risk HPV group.
 Oncology Letters, 11
(2), 1447. doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.3892/ol.2015.407

Tornesello, M. L., Buonaguro, L., Giorgi-Rossi, P., & Buonaguro, F. M. (2013). Viral and cellular biomarkers in the diagnosis of cervical intraepithelial neoplasia and cancer. 
BioMed research international
, 
2013
, 519619. https://doi.org/10.1155/2013/519619 Low-grade Cervical Dysplasia -cellular alteration & prognosis Low-grade Cervical Dysplasia -cellular alteration & prognosis

 

Low-grade Cervical Dysplasia -cellular alteration & prognosis
Discussion 1

See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal.  Her provider diagnosed her with low-grade cervical dysplasia.  What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. Low-grade Cervical Dysplasia -cellular alteration & prognosis

The terms cervical dysplasia and cervical intraepithelial neoplasia can be used interchangeably. Malignancies of the epithelial region are termed carcinomas. Dysplasia is a broad term that can refer to the abnormal development of cells. Cervical dysplasia is a pathologic finding associated with a predisposition and can progress further, according to Hammer and McPhee (2019). This disease can be found with a cervical biopsy or examination.

There are some alterations at the cellular level with this disease. It can start with either genomic instability, impaired DNA repair, or lack of cell cycle checkpoint control. It then turns to enhanced proliferation, abnormal cell cycle control, and autonomous growth. This leads to an evasion of the immune system and later, tissue. There is enhanced cell motility and the ability to gain access to blood vessels, which can eventually lead to the ability to recruit vascularization to support the growth of a tumor (Hammer & McPhee, 2019) Low-grade Cervical Dysplasia -cellular alteration & prognosis.

S.V’s prognosis is fairly good. Cervical intraepithelial neoplasia is graded by levels 1, 2 and 3. Level 1 is considered low grade. Because of this, S.V. has the highest rate of spontaneous regression, according to Flagg et al. (2016). Since she caught it early, she should have access to aggressive treatment early on.

There is a 40% incidence rate in women with HPV related cervical dysplasia. Without proper treatment and screening, this can progress to invasive cervical carcinoma, according to Hammer and McPhee (2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis This means that the basement membrane has been broken and can now metastasize to other areas of the body. Usually, epithelial neoplasms spread to regional nodes. Receiving the HPV vaccine is a valuable tool considering the prognosis of this disease, according to Hong et al. (2016). High-grade lesions are less likely to form if the vaccine is given. According to Flagg et al. (2016), declines in cervical dysplasia are most noted in countries with higher insurance coverage, thus leading more people to receive the vaccine. Low-grade Cervical Dysplasia -cellular alteration & prognosis

 

References:

Flagg, E. W., Torrone, E. A., & Weinstock. H. (2016). Ecological association of human papillomavirus vaccination with cervical dysplasia prevalence in the United States. American Journal of Public Health, 106(12). Low-grade Cervical Dysplasia -cellular alteration & prognosis

Hammer, G.D. & McPhee, S.J., (2019). Pathophysiology of disease: An introduction to clinical medicine (8
th
 ed.). New York, NY: McGraw-Hill Education/Medical.

Hong. C., Liu, X., & Xu, L. (2016). Incisal margin condition after LEEP for cervical intraepithelial neoplasia patients and prognosis. Experimental and therapeutic medicine, 12 (1).

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See Van does have a heightened risk for cervical cancer based on her ethnicity. Cervical cancer is among the top 5 cancers affecting Asian-American and Pacific Islander (AAPI) women (Hee Yun et al, 2015). Noting this factor before discussing her results and treatment plan is important because it could impact her decision for future testing. This patients Pap smear showed dysplasia which shows, a reversion to more immature cells without a committed identity (Hammer & McPhee, 2019). There are several ways that this diagnosis can be handled, some of the treatment methods depend on what the patient wants and what options are provided for them to choose from.  In the Hmong-American culture it is important to note that, spiritually-based health beliefs can be a barrier to cancer screening because the individual will try to turn to spiritual remedies instead of seeking preventive Western care, such as a Pap test (Hee Yun et al, 2015) Low-grade Cervical Dysplasia -cellular alteration & prognosis. See Van may already have a predisposition to avoid modern testing and medicine due to her cultural beliefs. Cervical dysplasia, without proper screening for early detection and treatment, can progress to invasive cervical carcinoma (Hammer & McPhee, 2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis This is important to share with the patient as one of the options is to wait and see if new changes occur on the next Pap smear. If a pap test is positive recommendations can include an immediate colposcopy, repeat cytology at 6 and 12 months, or HPV testing with a referral for colposcopy (Rebar et al. 2019). If further testing revealed a need for treatment then there are other options including cryosurgery, laser ablation, and loop electrosurgical excisional procedure for preinvasive lesions. Overall, her prognosis could be very good if she chooses to undergo further testing and treatment, however, if she chooses to wait or not seek treatment then the cervical dysplasia may progress into cervical cancer leading to further complications and poorer prognosis. Low-grade Cervical Dysplasia -cellular alteration & prognosis

References:

Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine 8e (8th ed.). Mcgraw-hill Education / Medical.

Hee Yun Lee, Pa Nhia Yang, Do Kyung Lee, & Rahel Ghebre. (2015). Cervical Cancer Screening Behavior among Hmong-American Immigrant Women. American Journal of Health Behavior, 39(3), 301–307. https://doi-org.americansentinel.idm.oclc.org/10.5993/AJHB.39.3.2

Rebar Cherie R., Heimgartner Nicole M., Gersch Carolyn J, (2019). Pathophysiology made incredibly easy! (6th ed.). Wolters Kluwer. Low-grade Cervical Dysplasia -cellular alteration & prognosis

Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Transcript

Started:
 Jan 23, 2021 | 
Total Time:
 185 min

All Lines (135)
Interview Questions (76)
Statements (29)
Exam Actions (30)

Begin by confirming the patient’s name and date of birth. Which of the following is the most appropriate way to do so?

Hello. I’ll be taking care of you tonight. Can you tell me your name and when you were born?

Question

01/23/21 6:33 PM PST

Hey . . . Gabriel . . . I’m 8 . . .”

His name is Gabriel Martinez. Gabriel is 8. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

You should also confirm Ms. Martinez’s relationship with Gabriel. Which of the following questions is the most appropriate way to do so?

Hello. Are you Gabriel’s guardian?

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Question

01/23/21 6:34 PM PST

Yes. I’m his mother.

Which of the following actions should you perform first?

I want to interview the patient and guardian to establish Chief Complaint.

Question

01/23/21 6:37 PM PST

What brings you in today?

Question

01/23/21 6:38 PM PST

It’s really hard to breathe . . . I have asthma . . .

Yes, my son started having difficulty breathing after school today. It’s been about 4 hours or so.

What should you do next?

Now that I have established Gabriel’s chief complaint, I need to take his vitals and conduct a pediatric asthma severity (PAS) score to better understand the severity of the patient’s condition.

Question

01/23/21 6:39 PM PST

Perform all of the following assesments and record the vitals in your EHR. Use the PAS Score tab in the EHR to calculate Gabriel’s total score and choose the appropriate exacerbation severity for Assessed PAS – PreIntervention in the Objective Data tab. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

 Auscultated breath sounds: expiratory and inspiratory wheezing

Exam Action

01/23/21 6:40 PM PST

Select your next course of action.

 Inpected chest: Mild intercostal retractions visible

Exam Action

01/23/21 6:43 PM PST

Select your next course of action.

 You observe so far during the assessment that Gabriel is speaking in partial sentences before having to take a breath.

Exam Action

01/23/21 6:44 PM PST

Select your next course of action.

 Assessed vitals

Exam Action

01/23/21 6:45 PM PST

Select your next course of action.

Now choose the corresponding severity description under Assessed PAS-PreIntervention in the Objective Data tab.

You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?

Now that I have determined Gabriel’s chief complaint, vitals, and PAS score, I have enough information to initiate the Asthma Exacerbation Protocol and finally relieve Gabriel’s respiratory distress.

Question

01/23/21 7:14 PM PST

Unfortunately, you have not collected enough information about Gabriel’s condition to initiate a protocol at this time.

You have not selected the most critical and necessary action. The incorrect response you selected has been removed. Try again with the remaining responses.

You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?

I want to get a spirometer reading to confirm my findings so far. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Question

01/23/21 7:14 PM PST

I did one before we came in.

Your second choice is not the most critical and necessary action, either. The incorrect responses you have selected have been removed. Select the correct response, and you will move on to the next question.

You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?

I want to ask about allergies to medication.

Question

01/23/21 7:15 PM PST

No, he doesn’t have medicine allergies.

You’ve determined the patient’s chief complaint, collected vitals and a PAS score, and inquired about medicine allergies. What should you do next?

In order to rule out additional respiratory complications, I need to ask a handful of key history of present illness questions.

Question

01/23/21 7:15 PM PST

At this stage you have collected the necessary and critical information to safely initiate the asthma exacerbation protocol. Any other assessments or tests are unnecessary at this time.

You have not selected the most critical and necessary action. The incorrect response you selected has been removed. Try again with the remaining responses.

You’ve determined the patient’s chief complaint, collected vitals and a PAS score, and inquired about medicine allergies. What should you do next?

I want to inform the patient and his guardian that I have determined that Gabriel is experiencing a moderate asthma exacerbation and am ready to begin treatment. I will ask them if they have any questions or anything else they’d like to tell me before I order the initiation of the Shadowville General Hospital Asthma Exacerbation Protocol. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Question

01/23/21 7:16 PM PST

No. No questions, thank you.

Your assessment of Gabriel has determined he is currently experiencing a moderate asthma exacerbation. Your protocol order is approved and you administer albuterol via nebulizer and prednisone orally.

Hello Gabriel, I am Nurse xxxx and I will be interviewing you and later perform a physical assessment

Greet

01/23/21 7:23 PM PST

Hey.

How are you feeling?

Question

01/23/21 7:24 PM PST

I feel better now . . . I can definitely breathe better, but my chest is kinda sore.

Sorry about your chest being sore

Empathize

01/23/21 7:25 PM PST

Everyone is really nice here. Thank you very very very much!

How does your chest feel?

Question

01/23/21 7:26 PM PST

My chest doesn’t feel as tight now. It’s still a little sore though. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Do you feel any wheezing?

Question

01/23/21 7:26 PM PST

My breath was squeaky earlier, but I can’t hear it anymore.

Okay, got it

Empathize

01/23/21 7:26 PM PST

Thanks, that makes me feel better.

When did the breathing problem start?

Question

01/23/21 7:27 PM PST

My attack started after kickball . . . and it got worse and worse when we got home.

Sorry about that Gabriel

Empathize

01/23/21 7:27 PM PST

Oh wow, thanks.

What worsens the breathing problem?

Question

01/23/21 7:27 PM PST

Ummmm smokers. Smoke makes my breathing a lot worse.

Sorry about that

Empathize

01/23/21 7:28 PM PST

Ok, thanks.

Are you normally around smoke?

Question

01/23/21 7:28 PM PST

I try to stay away from it. But these new kids were smoking by the kickball field after school today.

It is good to stay away from anyone smoking

Educate

01/23/21 7:29 PM PST

I guess that makes sense.

What triggers your asthma?

Question

01/23/21 7:29 PM PST

Smoke bothers me a lot. I try to stay away from it. But today some kids I’ve never seen before were smoking at my afterschool program.

What action did you take after the asthma attacK

Question

01/23/21 7:30 PM PST

Well I . . . I guess I’m supposed to take my emergency inhaler, but . . . I threw it away. So we don’t have it anymore.

Ooh, you should always ensure you have the inhaler at a safe and accessible place

Educate

01/23/21 7:31 PM PST

Ohhh, yeah. Good . . . to . . . know.

What is the name of the inhaler you were using?

Question

01/23/21 7:31 PM PST

I dunno. I think my mom does.

Why did you throw away the inhaler?

Question

01/23/21 7:32 PM PST

I hate the way that inhaler makes me all . . . shaky. It makes my heart beat too fast. That’s why, when my mom told me to clean out my backpack, I threw it in the trash.

Sometimes I give him an over the counter antihistamine, when his allergies are bad or the pollen count is high.

What are some of your son’s allergies? (No matching questions found.)

Question

01/23/21 8:09 PM PST

alleges? (No matching questions found.) Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Question

01/23/21 8:09 PM PST

Any allergies?

Question

01/23/21 8:09 PM PST

I don’t, no. Just my son does. [AUDIO COMING SOON]

What allergies does your son have?

Question

01/23/21 8:10 PM PST

Pets, dust, pollen. He’s not allergic to any of the other obvious stuff. No food or medicine or latex or anything.

How does your son’s environmental allergies impact his asthma?

Question

01/23/21 8:11 PM PST

Gabriel’s allergies always make his asthma worse. I can and do keep dust and dander out of the house, but pollen is a different story. The last time he had trouble with his asthma like this was during pollen season.

It is always good to keep the allergy triggers away

Educate

01/23/21 8:12 PM PST

Yeah . . . Yeah, I get it. We’ll work on that.

Has your son been hospitalized before?

Question

01/23/21 8:13 PM PST

Yes, he went to the hospital a year ago, because of his asthma.

Sorry about that. Being hospitalized can really take a toll on any parent Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Empathize

01/23/21 8:14 PM PST

Thank you for saying that.

Why was your son last hospitalized?

Question

01/23/21 8:14 PM PST

He was hospitalized last year because of his asthma. The night before, he was around some smoke — cigarette smoke, and maybe smoke from fireworks . . . We tried his rescue inhaler at home, but it wasn’t working, so I brought him to the ER. Kind of similar to this time, actually.

Sorry about that ordeal.

Empathize

01/23/21 8:15 PM PST

Thank you. I’m . . . I’m just doing the best I can.

Please let him always keep away from triggers such as smoke

Educate

01/23/21 8:16 PM PST

Alright, I understand.

How does exercise impact your son’s asthma?

Question

01/23/21 8:16 PM PST

Too much exercise could trigger an asthma attack. He knows the rules. He can walk, but he isn’t supposed to run.

Does anyone in your family use tobacco?

Question

01/23/21 8:17 PM PST

No, none of us do.

That is great. Smoking is really bad for health, especially in people with respiratory problems such as asthma

Educate

01/23/21 8:18 PM PST

That makes a lot of sense, thank you.

What is your childcare situation?

Question

01/23/21 8:18 PM PST

I work 55 hours a week. Gabriel goes to after-school clubs, so I pick him up around 5:30. He’s really close to my parents, so sometimes on the weekends he spends the night with his Lito and Lita. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Raising a child alone is really challenging. I know you are a great parent. Even Gabriel really appreciates you. But I am aware being a single parent can be difficult. You are really doing a great job by taking care of your son alone

Empathize

01/23/21 8:22 PM PST

Thank you for saying that.

What is your childcare situation?

Question

01/23/21 8:23 PM PST

I work 55 hours a week. Gabriel goes to after-school clubs, so I pick him up around 5:30. He’s really close to my parents, so sometimes on the weekends he spends the night with his Lito and Lita.

What health problems run in your family?

Question

01/23/21 8:23 PM PST

There’s nothing like asthma in the family. But my father has heart disease and my brother has diabetes.

Sorry about your father and brother’s conditions.

Empathize

01/23/21 8:24 PM PST

Thank you. I’m . . . I’m just doing the best I can.

Also sorry about your son’s asthma. He will get better.

Empathize

01/23/21 8:24 PM PST

Thanks, I appreciate that.

 Checked ID band

Exam Action

01/23/21 8:27 PM PST

 Assessed vitals

Exam Action

01/23/21 8:27 PM PST

 Auscultated top right chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated top left chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated upper right chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated upper left chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated lower right chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated lower left chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated top left back breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated top right back breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated upper left back breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated upper right back breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated lower left back breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated lower right back breath sounds: normal breathing

Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Exam Action

01/23/21 11:11 PM PST

 Auscultated lower left chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated lower right chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated upper right chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated upper left chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated top left chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated top right chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 No abnormal findings

Exam Action

01/23/21 11:11 PM PST

 Assessed dyspnea

Exam Action

01/23/21 11:13 PM PST

 PAS Score: determine the PAS Score using the EHR tab

Exam Action

01/23/21 11:19 PM PST

 Assessed growth

Exam Action

01/23/21 11:21 PM PST

 Assessed vitals Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Exam Action

01/23/21 11:23 PM PST

NURS – 6521N Advanced Pharmacology Midterm Exam

 

Question 1

A 77-year-old man’s chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect? NURS – 6521N Advanced Pharmacology Midterm Exam

The man’s glomerular filtration rate and creatinine levels are within reference ranges.

The man’s heart rate is between 60 and 70 beats per minute with a regular rhythm.

The man’s potassium and sodium levels remain with reference ranges.

The man’s chest sounds are clear and his ankle edema is lessened.

D

 

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question 2

Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine?

The resident has not eaten breakfast because of a recent loss of appetite

The resident’s apical heart rate is 112 beats/minute with a regular rhythm

The resident had a fall during the night while transferring from her bed to her bathroom

The resident received her annual influenza vaccination the previous day

B

 

 

 

 

Question 3

To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic patient, as the patient regains consciousness, the nurse should

administer calcium supplements.

position the patient in the side-lying position.

administer carbohydrates.

monitor for nausea and vomiting.

NURS – 6521N Advanced Pharmacology Midterm Exam

C

 

 

 

 

Question 4

Which statement is 
FALSE
 regarding the treatment of hyperthyroidism?

Long-acting beta-blocking agents are given as adjunctive therapy until Propulthiouracil (PTU) or methimazole (Tapazole) restores the patient to euthyroid

Methimazole (Tapazole) is the drug of choice for pregnant or lactating females.

Propylthiouracil (PTU) reduces peripheral conversion of T4 to the more potent T3

Since methimazole (Tapazole) is stronger than Propylthiouracil (PTU), Methimazole should be initiated at 15 mg/day compared to 300 mg/day for Propylthiouracil for treatment of mild disease

D

Question 5

A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient’s medication regimen. Which of the patient’s medications should prompt the nurse to teach her to avoid drinking grapefruit juice?

Atorvastatin (Lipitor)

Rabeprazole (Aciphex)

Vitamin D

Citalopram (Celexa)

A

 

 

 

 

Question 6

A 65-year-old male presents with a history of worsening urinary urgency, frequency, and hesitancy. He also tells you that he has to “push really hard” to urinate and that his urine dribbles a little after he is done urinating. What medication should be avoided NURS – 6521N Advanced Pharmacology Midterm Exam

 

paroxetine

ipratropium inhaler

omeprazole

clonidine

A

 

 

 

uestion 7

A 39 y/o female is diagnosed with Graves disease.  She also has a small goiter =.  Her symptoms are not deemed to be severe and propylthiouracil is prescribed.  Whare is the most serious potential adverse effect of this medication?

Hypocalcemia

Renal Failure

Agranulocytosis

Hematouria

C

 

 

uestion 10

Which of the following patients is most likely to benefit from the administration of an adrenergic agonist?

A man who is in cardiogenic shock following a myocardial infarction

A man who has a diagnosis of primary hypertension

NURS – 6521N Advanced Pharmacology Midterm Exam

A woman who has been admitted with a suspected ischemic stroke

A woman who is in labor and may require a caesarean section

A

 

Question 11

A male patient who is hypertensive takes Hydrochlorothiazide for his blood pressure . He  presents with red, painful swelling of the great toe. In addition to treating gout, you recognize that you may need to:

Increase his HCTZ

Order laboratory studies for diabetes

Change his thiazide antihypertensive medication

Advise him to lose weight

C

 

 

 

 

Question 12

A patient has been prescribed a drug that can be self-administered at home. NURS – 6521N Advanced Pharmacology Midterm Exam. Which of the following would be the most important information for the nurse to relate to the patient concerning self-administration of a drug?

Where to purchase the medication

The cost of the drug

The therapeutic effects and possible adverse effects

The pharmacokinetics of the drug

C

 

 

 

 

 

Question 13

A 79-year-old woman who takes several medications for a variety of chronic health problems has been prescribed an oral antiplatelet aggregator that is to be taken once daily. The nurse has encouraged the woman to take the pill at the same time of day that she takes some of her other medications. What is the most likely rationale for the nurse’s advice?

Integrating the new drug into the patient’s existing schedule promotes adherence.

Combining a new drug with one or more existing drugs mitigates the risk of adverse effects.

Taking several drugs at one time maximizes recovery time for the liver and kidneys.

Rapid drug clearance fostered when a patient is able to minimize the number of drug administration times.

A

 

 

 

 

Question 14

A 
Nurse Practitioner
 is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. NURS – 6521N Advanced Pharmacology Midterm Exam. The Nurse Practitioner suspects that the change in the effectiveness of the drug is related to

the impact of the placebo effect on the patient’s response.

the accumulative effect of the drug if it has been taken for many years.

the impact of the warmer climate on the patient’s physical state.

problems with patient compliance with the drug regimen due to the move.

C

 

 

 

 

Question 15

A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be

liquid.

lozenge.

tablet.

suppository.

D

 

 

 

Question 16

A patient with unstable angina pectoris who is NOT controlled with a nitrate would likely benefit most from the addition of:

1.

Sodium channel blocker

2.

Beta blocker

3.

Cardiac glycoside

4.

Either 1 or 2

C

 

Question 17

When prescribing an antihypertensive medication for a type 2 diabetic patient, the drug classifications that would tend to reduce insulin sensitivity are:

 Diuretics and calcium channel blockers.

Diuretics and beta blockers.

Calcium channel blockers and ACE inhibitors.

Alpha blockers and ACE inhibitors. NURS – 6521N Advanced Pharmacology Midterm Exam

B

 

 

 

 

Question 18

A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to

crush the tablet before swallowing.

swallow the tablet whole. NURS – 6521N Advanced Pharmacology Midterm Exam

swallow the tablet with milk or food.

avoid drinking milk for 3 hours after swallowing the tablet.

C

 

 

 

Question 19

A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain?

Call the physician

Ask the patient to lie back and try to relax

Have the patient swallow a tablet every 5 minutes for 15 minutes

Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided

D

 

 

 

Question 20

After a recent history of shortness of breath that has become increasingly severe, a woman has been prescribed ipratropium by MDI while she undergoes a diagnostic workup. What patient teaching should the nurse provide to this patient?

“Make sure that you take this at the scheduled times, regardless of whether you feel short of breath.”

“Most people find that ipratropium cures their lung disease within a few months.”

“You should think of this as an ’emergency drug’, and it should only be used when you experience symptoms.”

“It’s important that you perform deep breathing exercises before and after taking ipratropium.”

 

 

Question 77

A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man’s most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man’s serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings?

The man may be experiencing a paradoxical effect of aspirin

The man may be allergic to aspirin

The man may be experiencing liver toxicity from the aspirin

The man may be experiencing nephrotoxic effects of aspirin

D

 

 

Question 78

A patient receives 25 units of NPH insulin at 7.AM. NURS – 6521N Advanced Pharmacology Midterm Exam. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?

After breakfast

Before lunch

Late afternoon

Bedtime

C

 

 

estion 79

A patient is recovering from an acute episode of thrombophlebitis and is being treated with warfarin (Coumadin) 5 mg PO daily. In reviewing medication information, the Nurse Practitioner would include what information in their teaching?

Maintain close watch on Intake and Output

Do not take a multivitamin supplement

Limit dairy products

Aerobic exercises are the most effective

B

 

 

 

 

 

estion 80

A 47-year-old woman has been diagnosed with open-angle glaucoma. Pilocarpine drops are prescribed. The nurse’s assessment reveals that the patient has worn soft contact lenses for 15 years. The nurse will instruct the patient to

apply the contact lenses and wait 5 minutes before applying the drops.

remove the contact lenses before applying the drops.

apply the drops directly on the contact lenses.

stop wearing the contact lenses during the pilocarpine therapy. NURS – 6521N Advanced Pharmacology Midterm Exam

B

 

 

 

ion 82

A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his “puffers”. In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to

permanent liver damage.

rebound bronchoconstriction.

community-acquired pneumonia.

severe anticholinergic effects.

B

 

stion 81

A nurse practitioner understands when prescribing a medication that there are certain questions to address. Check all that apply.

Is there a need for the drug in treating the presenting problem?

Is this the best drug for the presenting problem?

Can the patient take the prescribed drug?

None of the above.

A

B

C

 

 

 

 

Question 83

A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient’s subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education NURS – 6521N Advanced Pharmacology Midterm Exam. What should the nurse teach the patient about her new medication?

“By reducing the amount of fluid that your body contains, digoxin will make it easier for your heart to pump.”

“This will lessen the workload of your heart by reducing your blood pressure.”

“Most patients see their heart failure resolve in 2 to 4 months after they begin taking digoxin.”

“This drug won’t cure your disease, but it will help you be able to exercise more and be more comfortable.”

D

 

 

 

 

 

 

Question 84

A Nurse Practitioner is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which of the following actions should the Nurse Practitioner take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment?

Avoid OTC antacids for the duration of treatment

Advocate for intravenous, rather than oral, administration

Teach the patient strategies for dealing with headaches

Carefully assess the patient for infections

D

 

 

Question 85

A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by

blocking adrenergic receptors and producing antisympathetic effects.

inhibiting the movement of calcium ions across the cardiac muscle cell membrane.

decreasing sodium and potassium conduction.

weakening diastolic depolarization and the action potential duration.

B

 

 

 

Question 86

The APRN would use what class of medication to manage COPD?

 

Mucolytic agents

Methylxanthine derivatives

Anticholinergic agents

Short-acting and long acting inhaled beta2 agonists

D

 

Question 87

A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of

an adrenergic antagonist.

an adrenergic agonist.

a cardiotonic.

a neurotransmitter.

A

 

 

 

 

Question 88

The Nurse Practitioner is treating a patient that takes frequent doses of antacids for his heartburn and is also taking an enteric coded aspirin.  What instructions should be provided to the patient?

The aspirin is less effective when taken with an antacid so you need to increase the dose.

The antacid destroys the aspirin so you should stop taking any antacids

The medications should be taken at least 2 hours apart. NURS – 6521N Advanced Pharmacology Midterm Exam

There is no effect of the antacid on the aspirin so they can be taken when it is convenient for you

C

 

 

 

Question 94

A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which of the following is an appropriate response by the nurse?

“Sure, you may take an antacid with ranitidine.”

“No, the two drugs will work against each other.”

“Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine.”

“I wouldn’t advise it. You may experience severe constipation.”

B

 

 

 

 

Question 95

Mr. Contreras is a 64-year-old patient with Type 2 diabetes. He has recently been diagnosed with hypertension. Which antihypertensive drug is the recommended choice to treat hypertension in patients with diabetes?

Diuretics

Beta Blocker

Calcium Channel Blocker

ACE Inhibitor

D

 

 

 

 

 

Question 96

A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an expectorant). What special instructions should the nurse include in the patient teaching for this situation?

Wash hands before and after taking the medicine

Keep track of any gastrointestinal tract infections

Monitor glucose levels closely

Note the time the medicine is taken each day

C

 

 

 

 

 

Question 97

A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is NURS – 6521N Advanced Pharmacology Midterm Exam

headache.

irritability.

dry mouth.

heart palpitations.

A

 

 

 

 

 

 

 

Question 98

A Nurse Practitioner is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following?

The amount of the drug that must be given to produce a particular response

How well a drug produces its desired effect

A drug’s strength of attraction for a receptor site

A drug’s ability to stimulate its receptor

B

 

 

 

 

Question 99

The APRN is seeing Mrs. Smith, age 77, who is here for follow up of hypertension, dyslipidemia, and depression.  What should you consider during her follow-up?

 

Changes in lean body mass and fluids have little effect on drug serum concentrations

No alteration in dosing is required with low albumin levels and protein bound drugs

The effects of cardiovascular and CNS medications are predictable in older adults

Age-related changes in renal function are the main cause of adverse drug reactions

D

 

 

 

 

Question 100

The APRN should educate a diabetic patient that beta blockers may mask the signs and symptoms of

insulin resistance

insulin sensitivity

hypoglycemia

hyperglycemia

NURS – 6521N Advanced Pharmacology Midterm Exam

NURS 6512 Midterm Exam Review (Week 1-6)

Building A Complete Health History

Communication techniques used to obtain a patient’s health history

Recording and documenting patient information

SOAP note documentation

Subjective vs objective information when documenting

Ethical decision making and beneficence

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Diversity and Health Assessments

Cultural awareness and diversity

Socioeconomic, spiritual, and lifestyle factors affecting diverse populations

Functional assessments

NURS 6512 Midterm Exam Review (Week 1-6)

 

Assessment Tools and Diagnostic Tests in Adults and Children

Growth, Development, and Measurements in children and adults

Nutritional assessment to include recommended water intake and energy requirements

Macronutrients vs Micronutrients

Significance of a food diary

NURS 6512 Midterm Exam Review (Week 1-6)

BMI measurements for normal, overweight, obesity, morbid obesity

Pernicious Anemia

Examination techniques and equipment

Diagnostic Assessment tools and tests to include tuning forks, BP monitoring, use of stethoscope, otoscope, ophthalmoscope

 

Assessment of the Skin, Hair, and Nails

Skin lesion characteristics

Documenting skin lesions using “ABCD” rule

Anatomy and physiology of skin layers

Abnormal nail findings in older adults

Psoriatic skin lesions

NURS 6512 Midterm Exam Review (Week 1-6)

Vesicular skin characteristics

Normal vs abnormal hair distribution during aging

Characteristics of hair distribution

Assessment of Head, Neck, Eyes, Ears, Nose, and Throat

Cranial Nerves associated with the HEENT system

Normal assessment findings of an adolescent’s nose and throat

Normal examination findings of an infant’s fontanelles

Examination findings of a patient with hypothyroid and hyperthyroid

Techniques for examining the HEENT systems

NURS 6512 Midterm Exam Review (Week 1-6)

Examination findings for a patient with sinus symptoms

Appropriate tuning fork frequencies to approximate vocal frequencies

Examining the oral mucosa

Hearing loss findings when examining the elderly patient

Examination techniques used to examine the trachea and thyroid

 

Assessment of the Abdomen and Gastrointestinal System

Organs involved in the alimentary tract

Correct assessment order for examining the abdomen

Examination technique and findings of the liver

Examination findings associated with appendicitis

Examining McBurney’s sign

Assessment of abdominal pain in women

Landmarks for abdominal examination

Characteristics of bowel sounds heard during auscultation

NURS 6512 Midterm Exam Review (Week 1-6)

,

NRNP 6531 week 3 Knowledge Check: Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions

Question 1

The Centor criteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following?

Fever history

Tender, swollen anterior cervical lymph nodes

Positive rapid antigen detection test

A and B only

A, B, and C

1 points

A and B only

NRNP 6531 week 3 Knowledge Check: Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions Question 2

Marvin has sudden eye redness that occurred after a strenuous coughing episode. You diagnose a subconjunctival hemorrhage. Your next step is to

a.

Refer him to an ophthalmologist

b.

Order antibiotics

c.

Do nothing other than provide reassurance

d.

Consult with your collaborating physician

1 points

Do nothing other than provide reassurance

Question 3

Which of the following is a predisposing condition for furunculosis?

a.

Diabetes mellitus

b.

Hypertension

c.

Peripheral vascular disease

d.

Chronic fatigue syndrome

1 points

Diabetes Mellitus

Question 4

If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:

a.

Iritis

b.

Allergic conjunctivitis

c.

Viral conjunctivitis

d.

Bacterial conjunctivitis

1 point

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Iritis

Question 5

Which of the following statements about malignant melanomas is true?

a.

They usually occur in older adult males

b.

The patient has no family history of melanoma

c.

They are common in blacks

d.

The prognosis is directly related to the thickness of the lesion

 

NRNP 6531 week 3 Knowledge Check: Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions 1 points

The prognosis is directly related to the thickness of the lesion

Question 6

A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed?

Any recent trauma

Difficulty swallowing

Stiffness in the right shoulder

Change in sleeping habits

1 points

Any recent trauma

 

Question 7

Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect?

a.

Cataracts

b.

Glaucoma

c.

Retinal detachment

d.

Iritis

1 points

Retinal detachment

 

Question 8

Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate?

An antihistamine intranasal spray

A decongestant nasal spray

Ipratropium

Omalizumab

1 points

Decongestant nasal spray

NRNP 6531 week 3 Knowledge Check: Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions Question 9

Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices?

a.

It is important to “undercode” so that one does not get charged with Medicare fraud

b.

The practice of “overcoding” is essential in this age of decreasing reimbursements

c.

Failing to bill for billable services will lead to unnecessarily low revenues

d.

Time spent with the patient is a very important determinant of billing

1 points

Failing to bill for billable services will lead to unnecessarily low revenues

Question 10

A 19 year old basketball player complains of itching in the crural folds, buttocks, and upper thighs. The lesions are well demarcated and are half-moon shaped. The area is red, irritated, and there are small breaks in the skin from scratching. What is this patient’s diagnosis and how should it be treated?

a.

Tinea cruris; treat with a topical antifungal cream

b.

Eczema; treat with a topical steroid

c.

Scabies; treat with permethrin cream

d.

Syphilis; treat with penicillin

1 points

Tinea cruris

Question 11

A 45 year old with diabetes has had itching and burning lesions between her toes for 2 months. Scrapings of the lesions confirm the diagnosis tinea pedis. What is the best initial treatment option for this patient?

Prescribe an antifungal powder for application between her toes and in her shoes and a topical prescription strength antifungal cream for other affected areas. Monitor for a secondary bacterial infection.

Prescribe an oral antifungal for 4 to 12 weeks. Monitor BUN and creatinine at 1 week, 2 weeks, and every month thereafter.

Prescribe an oral antifungal for 4 to 12 weeks. Monitor liver enzymes, BUN, and creatnine at 1 week, 2 weeks, and every month thereafter.

Prescribe a prescription strength antifungal/steroid combination cream. Monitor for a secondary bacterial infection.

1 points

Prescribe and antifungal powder for application between her toes and in her shoes and a topical prescription strength antifungal cream

Question 12

A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him:

a.

“It is the most common cause of death in patients with skin cancer.”

b.

“It can be cured with surgical excision or radiation therapy.”

c.

“It is a slow growing skin cancer that rarely undergoes malignant changes.”

d.

“It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks.” NRNP 6531 week 3 Knowledge Check: Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions

1 points

It can be cured with surgical excision or radiation therapy

Question 13

Your 31-year-old patient, whose varicella rash just erupted yesterday, asks you when she can go back to work. What do you tell her?

a.

Once all the vesicles are crusted over

b.

When the rash is entirely gone

c.

Once you have been on medication for at least 48 hours

d.

Now, as long as you stay away from children and pregnant women

1 points

Once all the vesicles are crusted over

Question 14

Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?

a.

Pharmacological therapy

b.

A labyrinthectomy

c.

A vestibular neurectomy

d.

Wearing an earplug in the ear with the most hearing loss

1 points

A vestibular neurectomy

NRNP 6531 week 3 Knowledge Check: Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions Question 15

Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:

a.

Quit smoking

b.

Maintain aggressive hypertension therapy

c.

Stick to a low-fat, low-sodium diet

d.

Continue with his exercise program

1 points

Quit smoking

Question 16

Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order?

a.

Aspirin

b.

NSAIDs

c.

Opioids

d.

Antihistamines

1 points

Antihistamines

Question 17

Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:

a.

Herpes simplex

b.

Aphthous ulcers

c.

Candidiasis

d.

Oral cancer

1 points

Candidiasis

Question 18

Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules in that site. What do you suspect?

a.

Varicella

b.

Herpes zoster

c.

Syphilis

d.

Rubella

1 points

Herpes Zoster

Question 19

What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?

a.

You must initiate the plan of care for the patient

b.

The physician must be on-site and engaged in patient care

c.

You must be employed as an independent contractor

d.

You must be the main health care provider who sees the patient

1 points

The physician must be on-site and engaged in patient care

Question 20

Your well-nourished 75-year-old patient has come into the office for a physical exam and states that she recently had two nosebleeds. She does not take any anticoagulants, and you have ruled out any coagulopathies. The most likely cause of these nosebleeds is:

a.

Sex hormones

b.

Trauma or inflammation

c.

A dietary change

d.

Scurvy

Trauma or inflammation

NRNP 6531 week 3 Knowledge Check: Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions

Question 1

A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?

a.

Inferior wall

b.

Anterior wall

c.

Apical wall

d.

Lateral wall

1 points

Question 2

Other than smoking cessation, which of the following slows the progression of COPD in smokers?

a.

Making sure the environment is free of all pollutants

b.

Eliminating all pets from the environment

c.

Engaging in moderate to high levels of physical activity

d.

Remaining indoors with air conditioning as much as possible

1 points

Question 3

Which of the following is not a risk factor for coronary arterial insufficiency?

a.

Hyperhomocysteinemia

b.

Smoking

c.

Genetic factors

d.

Alcohol ingestion

1 points

Question 4

Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?

a.

It is not effective during an acute asthma attack.

b.

It may take 2 to 3 days to begin working.

c.

This drug works within 10 minutes.

d.

This drug may be used by patients 6 years and older.

1 points

Question 5

Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure?

a.

Increase her Lisinopril to 20mg daily

b.

Add a thiazide diuretic to the Lisinopril 5mg daily

c.

Discontinue the Lisinopril and start a combination of ACE Inhibitor and calcium channel blocker

d.

Discontinue the Lisinopril and start a diuretic

1 points

Question 6

What condition is associated with mucus production greater than 3 months per year for at least 2 consecutive years?

a.

Asthma

b.

Emphysema

c.

Chronic obstructive lung disease

d.

Chronic bronchitis

1 points

Question 7

Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?

a.

Xanthines

b.

Antihistimines

c.

Steroids

d.

Anticholinergics

1 points

Question 8

Which type of lung cancer has the poorest prognosis?

a.

Adenocarcinoma

b.

Epidermoid carcinoma

c.

Small cell carcinoma

d.

Large cell carcinoma

1 points

Question 9

Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?

a.

Mild intermittent

b.

Mild persistent

c.

Moderate persistent

1 points

Question 10

Which drug category contains the drugs that are the first line Gold standard therapy for COPD?

a.

Corticosteroids

b.

Inhaled beta-2 agonist bronchodilators

c.

Inhaled anticholinergic bronchodilators

d.

Xanthines

1 points

Question 11

Which of the following best describes hypertrophic cardiomyopathy?

a.

A weakened and enlarged myocardium

b.

Poor ventricular filling and weakened myocardium

c.

Enlarged left ventricle and septum

d.

None of the above

1 points

Question 12

Risk factors for acute arterial insufficiency include which of the following?

a.

Recent myocardial infarction

b.

Atrial fibrillation

c.

Atherosclerosis

d.

All of the above

1 points

Question 13

A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?

a.

A long-acting bronchodilator

b.

An inhaled corticosteroid and cromolyn

c.

Theophylline and a short acting bronchodilator

d.

A bronchodilator PRN and an inhaled corticosteroid

1 points

Question 14

Management of a patient with hypertension and an abdominal aortic aneurysm would include:

a.

computed tomography scan without contrast

b.

changing the patient’s BP medications

c.

referral to a cardiologist

d.

immediate cardiac catheterization

1 points

Question 15

A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:

a.

Mitral regurgitation

b.

Systolic heart failure

c.

Cardiac myxoma

d.

Diastolic heart failure

1 points

Question 16

A patient presents to the office with a blood pressure 142/80. This patient is classified as having:

a.

Normal blood pressure

b.

Prehypertension

c.

Stage 1 hypertension

d.

Stage 2 hypertension

1 points

Question 17

Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?

a.

Chronic sinusitis

b.

Acute bronchitis

c.

Bacterial pneumonia

d.

Acute exacerbation of chronic bronchitis

1 points

Question 18

The most common correlate(s) with chronic bronchitis and emphysema is(are):

a.

Familial and genetic factors

b.

Cigarette smoking

c.

Air pollution

d.

Occupational environment

1 points

Question 19

Which of the following is not a goal of treatment for the patient with cystic fibrosis?

a.

Prevent intestinal obstruction

b.

Provide adequate nutrition

c.

Promote clearance of secretions

d.

Replace water-soluble vitamins

1 points

Question 20

In order to decrease deaths from lung cancer:

a.

All smokers should be screened annually

b.

All patients should be screened annually

c.

Only high risk patients should be screened routinely

d.

Patients should be counseled to quit smoking

N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

Module 2 Overview

Introduction

In this module students will review the normal anatomy and physiology of the heart and analyze the pathophysiology and clinical manifestations of selected cardiovascular disorders, including arrhythmias, congestive heart failure, valvular heart disease, and coronary artery disease.

Learning Objectives

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After completing this module, you will be able to:

Review normal physiology of the cardiovascular system

Explain pathophysiological alterations in the cardiac cycle.

Analyze the pathogenesis of alterations in heart function.

Summarize the major clinical manifestations and complications of alteration in heart functions

N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

Reading & Resources

Read Chapters 10 In Hammer, G. & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education / Medical

Optional readings:

Lindsell, C. J., Anatharaman, V., Diercks, D., et al. (2006). The internet tracking registry of acute coronary syndrome: A multicenter registry of patients with suspicion of acute coronary syndromes reported using the standardized reporting guidelines for emergency department chest pain studies. 
Annals of Emergency Medicine, 48
(6), 666-677. N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

Ringstrom, E., & Freedman, J. (2006). Approach to undifferentiated chest pain in the emergency department: A review of recent medical literature and published practice guidelines. 
Mt. Sinai Journal of Medicine, 73
(2), 499-505.

Learning Activities

Discussion
: Participate in Discussion 2.

Discussion 2

Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.

In this discussion:

Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?

Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?

Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?

Identify the pathophysiologic mechanism for her chest pain.

Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook. N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

N512- Advanced Pathophysiology Module 1 Overview

Introduction

In this module students will learn about the pathophysiology of genetic disease and neoplasia. Emphasis will be placed on students’ mastery of the mechanisms of mutation, inheritance patterns, and prevalence of genetic disease, and on the molecular and biochemical bases of neoplasia.

Learning Objectives

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After completing this module, you will be able to:

Explore key concepts related to the genetic basis of disease

Examine the spectrum of pathophysiologic characteristics of infectious diseases

Explain the pathophysiological alterations noted in neoplastic developments

N512- Advanced Pathophysiology

Reading & Resources

Read Chapters 2, 4 & 5 In Hammer, G. & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education / Medical

Visit
 Learn.Genetics.Utah.edu 
to learn more about genetic imprinting.

Optional Reading:

Kruyer, H., Milla, M., Carbonell, P., Ballesta, F., & Estivill, X. (1994). Fragile X syndrome and the (CGG)n mutation: Two families with discordant MZ twins. 
American Journal of Human Genetics, 54
(3), 437-442. (this is a classical study) N512- Advanced Pathophysiology

Activities

Introductions
: Introduce yourself in the Introductions forum.

Discussion
: Participate in Discussion 1. N512- Advanced Pathophysiology

Assignment
: Complete & Submit Assignment 1. Click on the Assignment 1 link for more details.

Review
: Review the Final Project details by clicking on the Final Project link at the top of the course in the Course Documents section or in Module 8.

Discussion 1

See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal.  Her provider diagnosed her with low-grade cervical dysplasia. N512- Advanced Pathophysiology What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

assignment 1

The purpose of this paper is to address the following clinical scenario with the use of your textbook, external credible literature, and/or reliable electronic sources. Use the guide below to draft your paper and review the rubric to ensure you have met the assignment criteria. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s) N512- Advanced Pathophysiology.

Lisa Anderson, a 22 y.o., Caucasian single parent, is referred for genetic counseling by her pediatric Nurse Practitioner. She has a 3-year-old boy with developmental delay and small joint hyperextensibility. The pediatric Nurse Practitioner has diagnosed fragile X-associated mental retardation. She is currently pregnant with her second child at 14 weeks of gestation. The family history is unremarkable N512- Advanced Pathophysiology.

 

Please use the following headings/subheadings as a guide to draft your paper:

Introduction (including a brief purpose statement)

Identify the genetic mutation responsible for fragile X-associated mental retardation.

Describe and discuss how it causes the clinical syndrome of developmental delay, joint hyperextensibility, large testes, and facial abnormalities.

Identify which parent is the probable carrier of the genetic mutation?

N512- Advanced Pathophysiology

Explain why this parent and the grandparents are phenotypically unaffected.

Discuss the likelihood that the unborn child will be affected?

VII. Conclusion

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 4-5 page limit)

Include transitions in your paper (i.e. headings or subheadings)

Use in-text references throughout the paper

N512- Advanced Pathophysiology

Use double space, 12 point Times New Roman font

Spelling, grammar, and organization are appropriate

Include a reference list (this is not part of the 4-5 page limit)

Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)

Assignment 1 Rubric

Criteria

60 Points

55 Points

50  Points

40 Points

Earned Points

Content: Application & Analysis

Responds correctly and/or appropriately to all questions and criteria. Content is excellent.

Demonstrates a high level of critical thinking, shows significant insight or creative thought about the topic, and does not merely recite the text/resources. Uses concepts and terminology correctly.  Detail rich and specific.

Responds correctly and/or appropriately to all questions and criteria. Content is good.

Demonstrates some critical thinking throughout the paper and may also show some insight or creative thinking about the topic. Mostly uses concepts and terminology correctly (1-2 issues). Minor detail inconsistencies (1-2).

Responds correctly and/or appropriately to at least one question OR if only one question, partially responds to question. Does not address all criteria. Content is minimal.

Demonstrates at least one critical thinking skill in the paper.  Attempts to use concepts and terminology correctly.  Several detail inconsistencies (3-5).

Paper is unclear and does not address the questions and/or criteria. Content does not meet requirements. Many inconsistencies and conflicting information (6+). N512- Advanced Pathophysiology

 

 

/60

Criteria

20 Points

16 Points

14 Points

12 Points

Earned Points

Quality: Supporting Research & Sources

All work is accurately cited (where applicable) and appropriately supports content with research, text, multimedia, and/or other resources.  References are relevant and enhance the topic.

Most of the work is accurately cited (where applicable) and adequately supports content with research, text, and/or resources.  One issue with reference or use of one inappropriate reference.  References are relevant to the topic.

2-3 issues with references, including the use of inappropriate references to support content. May fail to provide references to support content.  1-2 references are not relevant to the topic and/or distract from the topic at hand.

4 or more issues with references, including the use of inappropriate references to support content OR failure to include references (where applicable).  No supporting references are used OR they are used but 3+ references are not relevant to the topic.

/20 N512- Advanced Pathophysiology

Criteria

10 Points

8 Points

7 Points

6 Points

Earned Points

Organization

Paper is well-organized. Ideas are clear and arranged logically. Transitions are smooth, no flaws in logic. N512- Advanced Pathophysiology

Paper is organized. Ideas are usually clear and arranged in an acceptable sequence (1-2 issues). Transitions are usually smooth (1-2 issues), good support.

Paper lacks organization. There are many problems with the approach (3-5 issues with organization). Some difficulty understanding ideas.  Issues with support and transitions (3-5).

Paper is poorly organized and difficult to understand. Many issues with support and transitions (6+). Ideas are arranged illogically and do not make sense.

 /10

Accuracy & Basic Writing Mechanics

Error-free, including APA formatting, reflecting clear understanding of various forms of expression and careful editing.

Very few (less than 3) errors in spelling, grammar, syntax, and/or punctuation. Very few (less than 3) issues with APA formatting. Occasional poor choice of word.

4-5 errors in spelling, grammar, syntax, and/or punctuation. 4-5 issues with APA Formatting. Writing may be difficult to understand at times N512- Advanced Pathophysiology.

More than 5 errors in spelling, grammar, syntax, and/or punctuation.  Many (6+ issues with APA formatting.  Writing is difficult to understand in many instances.

 

Discussion 1

See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal.  N512- Advanced Pathophysiology Her provider diagnosed her with low-grade cervical dysplasia.  What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria N512- Advanced Pathophysiology.

The Hmong-American population has historically had a disparity with access to care.  Though in this case, it appears the SV is dialed into the healthcare system.  The cellular alterations most commonly associated with low-grade cervical dysplasia are due in large part to the junction of two different types of cellular tissue.  Human Papillomavirus is also a common cause of cervical dysplasia. N512- Advanced Pathophysiology The incidence of HPV is widely established to be a leading cause of low-grade cervical dysplasia and is associated with multiple sexual partners as well as early sexual activity.  The pap smear will show a squamous intraepithelial lesion of an LSIL.  There are over a hundred different strains of HPV.  The pap smear is a sample of cells from the squamocolumnar junction of the cervix where the columnar epithelium overlaps the smooth squamous epithelium.  junction area allows metaplasia that causes squamous cells to replace columnar cells. This transition point is often the site of dysplastic activity within the cells.  These changes are what often lead to cervical dysplasia N512- Advanced Pathophysiology.  HPV can attack the basal cells of the squamous epithelium of the cervix.  The DNA of the HPV replicates inside the host cell.  These changes are evident in a pathology evaluation of the cellular samples taken during the pap smear. (Cooper, 2020). The cells obtained during the pap smear will have an abnormal appearance on the pathology evaluation.

SV’s prognosis is a good one provided she is scrupulous with her designated follow up as additional pap smears may be required within 3-6 months.  Often, there is no treatment for the dysplasia except to follow them more closely and monitor frequent pap smears to see if there are signs of the cellular changes that can occur in neoplasia N512- Advanced Pathophysiology.  Provided SV continues to have access to care and follows the guidance of her midwife, her prognosis looks promising provided she continues to follow the guidance of her healthcare professional and continue to have per prescribed pap smears.

 

Fang, D. M., M.S.W., Lee, Serge,PhD., M.S.W., Stewart, S., PhD., Ly, M. Y., M.S.W., & Chen, Moon S, Jr,PhD., M.P.H. (2010). Factors associated with pap testing among hmong women.
 Journal of Health Care for the Poor and Underserved, 21
(3), 839-50. Retrieved from http://americansentinel.idm.oclc.org/login? N512- Advanced Pathophysiology

 

Adunlin, G., Cyrus, J. W., Asare, M., & Sabik, L. M. (2019). Barriers and facilitators to breast and cervical cancer screening among immigrants in the united states.
Journal of Immigrant and Minority Health, 21
(3), 606-658. doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.1007/s10903-018-0794-6

 

Shin-Young, L., & Lee, E. E. (2018). Cancer screening in koreans: A focus group approach.
 BMC Public Health, 18
doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.1186/s12889-018-5147-9 N512- Advanced Pathophysiology

 

Cooper DB, McCathran CE. Cervical Dysplasia. [Updated 2020 May 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430859/

 

Cervical dysplasia is also known as cervical intraepithelial neoplasia.  It is a premalignant disorder that is characterized by abnormal growth of the epithelial lining of the cervix (Smith & Holle, 2018).  Cervical dysplasia affects 3600 out of 100,000 people each year and the peak incidence is at 26 years old (Smith & Holle, 2018) N512- Advanced Pathophysiology.  Human Papillomavirus (HPV) is a common cause of cervical dysplasia.  Risk factors that increase the risk of HPV include: an illness that suppresses the immune system, taking immunosuppressant drugs, having numerous sexual partners, giving birth prior to age 16, having sexual intercourse before the age of 18, and smoking cigarettes (Smith & Holle, 2018).  Cervical dysplasia is detected by a Pap smear test and based on the abnormalities of the cells ranges from mild to severe (Smith & Holle, 2018).  Cell dysplasia is defined as a decline to a less mature cell without a specific identity (Moasser & Weiyun, 2019). N512- Advanced Pathophysiology On See Van’s Pap smear one would expect to see these mentioned immature cells.  Most HPV infections and low-grade lesions will resolve on their own within 8 months (Smith & Holle, 2018).  Typically a person will have a follow up Pap test to see if the cells have changed.  If the results are concerning the doctor may recommend a colposcopy to identify suspicious areas for biopsy (Smith & Holle, 2018). See Van will need to follow up with her gynecologist for a follow up Pap smear to determine cellular changes.  If resolved she would be advised to practice safe sex including monogamy. If her cells have progressed she may need to undergo treatments like “cryotherapy, laser surgery, loop electrosurgical excision procedure (LEEP) surgical ablation, and surgical excision” (Smith & Holle, 2018).  Treatment of cervical dysplasia is found to be beneficial in 80-90% of cases (Smith & Holle, 2018).  SV has a good prognosis if she is compliant with follow up, testing, and recommendations from her gynecologist. N512- Advanced Pathophysiology

 

References

 

Mark M. Moasser, M., & Weiyun, Z. Ai, P. M. (2019). Neoplasia. In G. D. Hammer, & S. J. McPhee, Pathophysiology of Disease: An Introduction to Clinical Medicine (pp. 89-139). NewYork: McGraw-Hill Education.

 

Smith, N., Holle, M. (2018). Cervical Intraepithelial Neoplasia (Cervical Dysplasia) and Human Papillmavirus. Cinahl Information Systems. Retrieved from 
https://web-a-ebscohost-com.americansentinel.idm.oclc.org/nrc/pdf?vid=8&sid=9f1f73aa-e078-4144-a2e9-e416593a7a31%40sdc-v-sessmgr03

 

Module 2 Overview

Introduction

In this module students will review the normal anatomy and physiology of the heart and analyze the pathophysiology and clinical manifestations of selected cardiovascular disorders, including arrhythmias, congestive heart failure, valvular heart disease, and coronary artery disease N512- Advanced Pathophysiology.

Learning Objectives

After completing this module, you will be able to:

Review normal physiology of the cardiovascular system

Explain pathophysiological alterations in the cardiac cycle.

N512- Advanced Pathophysiology

Analyze the pathogenesis of alterations in heart function.

Summarize the major clinical manifestations and complications of alteration in heart functions

Reading & Resources

Read Chapters 10 In Hammer, G. & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education / Medical

Optional readings:

Lindsell, C. J., Anatharaman, V., Diercks, D., et al. (2006). The internet tracking registry of acute coronary syndrome: A multicenter registry of patients with suspicion of acute coronary syndromes reported using the standardized reporting guidelines for emergency department chest pain studies. 
Annals of Emergency Medicine, 48
(6), 666-677 N512- Advanced Pathophysiology.

Ringstrom, E., & Freedman, J. (2006). Approach to undifferentiated chest pain in the emergency department: A review of recent medical literature and published practice guidelines. 
Mt. Sinai Journal of Medicine, 73
(2), 499-505.

Learning Activities

Discussion
: Participate in Discussion 2.

Discussion 2

Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward N512- Advanced Pathophysiology. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal N512- Advanced Pathophysiology.

In this discussion:

Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?

Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?

Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?

Identify the pathophysiologic mechanism for her chest pain N512- Advanced Pathophysiology.

Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria N512- Advanced Pathophysiology.

NURS 6521 Mid-Term Exam Summary & Study Guide

NURS 6521

Mid-Term Summary & Study Guide

 

100-question Exam which will assess your knowledge on the Learning Resources from Weeks 1-6

Time limit of 2 hours

Multiple choice or multiple selection

NURS 6521 Mid-Term Exam Summary & Study Guide

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Pharmacokinetics:

Understand the implications of changing renal function on creatinine and drug dosing.

What is the impact of the following on drug levels and dosing: NURS 6521 Mid-Term Exam Summary & Study Guide

Cirrhosis

Protein binding

Drug interactions

Half-life

Routes of Administration and Dosage Forms:

Understand the different routes of administration and dosage forms and some of the challenges and benefits associated with these routes and forms.

Understand when it is OK to crush (or not crush) certain dosage forms and why NURS 6521 Mid-Term Exam Summary & Study Guide.

Which routes of administration have the fastest and slowest rates of absorption?

Know the relative onset, monitoring and appropriate use of various dosage forms including:

Patches (ie; fentanyl, rivastigmine)

Suppositories (ie; acetaminophen)

Sublingual tablets

Tablets

Liquid (know common measures)

Injectables

Sublingual

Nasogastric

Elixir (contains alcohol)

 

Therapeutics:  
Gastrointestinal, Cardiac, Respiratory, Neurology, Musculoskeletal

Understand the mechanism of action, side effects, appropriate use and contraindications for the classes of drugs and individual drugs listed below. Also, know the key patient education points including cautions, expected effects, and appropriate use (with food, empty stomach, etc.).

Anti-diarrheals (diphenoxylate HCl with atropine sulfate, loperamide, bismuth subsalicylate)

Laxatives (fiber, osmotics, stimulants, other) NURS 6521 Mid-Term Exam Summary & Study Guide

Therapy for various gastrointestinal disorders including antiemetics, ulcers, irritable bowel syndrome, Crohn’s ulcerative colitis (ie; alosetron, PPIs like omeprazole, Mesalamine, ranitidine, etc.)

Cough, cold, and sinus therapies including antihistamines and cough suppressants (ie; dextromethorphan, loratadine, fexofenadine, nasal decongestants

Cardiac Medications – Digoxin (understand toxicity, dosing, use), Statins, Colestipol, Nitroglycerin

Blood pressure medications (calcium channel blockers, ACE Inhibitors, diuretics, beta-blockers, nitroprusside, others)

Diuretics (spironolactone, furosemide, hydrochlorothiazide)

Inhalers (albuterol, ICS, LABA, anticholinergics) NURS 6521 Mid-Term Exam Summary & Study Guide.

Asthma – Theophylline, zafikurlast, steriods and others

Gout and arthritis therapies (allopurinol, etanercept, sulfinpyraxone, methotrexate)

Antineoplastics (etoposide, 5FU, cisplatin, bicalutamide, others)

Agents for thyroid disease (Levothyroxine, methimazole and others)

Multiple sclerosis therapies (Dantrium, Glatirimer, Baclofen, Tizanidine, others)

Antiepileptics (phenytoin, ethosuximide, diazepam, others)

Osteoporosis (calcitonin, others)

Hypoglycemics (glyburide, glipizide, metformin, insulin, etc.)

Meds for Hyperlipidemia

Anticholinergics/Cholinergics

Pain (opioids, muscle relaxants, NSAIDs, acetaminophen, topical lidocaine, etc.)

Orlistat

Adrenergic agonists

NURS 6521 Mid-Term Exam Summary & Study Guide

 

Terminology:

Efficacy

Pharmacokinetics

Pharmacodynamics

Drug tolerance

Addiction

Dependence

Withdrawal

First pass effect

Idiosyncratic response

Medication Reconciliation

NURS 6521 Mid-Term Exam Summary & Study Guide

 

Other Topics:

Which drug classes produce withdrawal if stopped abruptly? When is withdrawal life threatening?

Understand the appropriate use of herbal therapies

Understand components of cultural competence

How can adverse drug events be minimized?

Why do drugs require clinical study and FDA approval?

Know common teaspoon, tablespoon, and milliliter conversions

Know DEA schedules and examples of therapies in each scheduled class (1-5). What are the special prescribing restrictions for these various classes?

Which medications should be taken with food? Which on an empty stomach?

What is the purpose of the MedWatch Program?

Symptoms and treatment of drug intoxication from cocaine, opioids, marijuana

Appropriate use of reversal agents for digoxin, opioids, etc.

Antihistamines

H1, H2 blockers

NURS 6521 Mid-Term Exam Summary & Study Guide