Nursing Care Scenarios and Best Practices, Exams of Advanced Education

Download Nursing Care Scenarios and Best Practices and more Exams Advanced Education in PDF only on Docsity! ACHPN Exam 108 Questions with Verified Answers APRN begins to overly identify with pain and suffering of patients; skips lunch, trouble concentrating, nightmares A. depression B. compassion fatigue C. anxiety D. empathy - CORRECT ANSWER B. compassion fatigue Patient with chronic bowel disease has developed persistent diarrhea, treatment most indicated to treat is: A. loperamide B. codeine C. diphenoxylate D. methylcellulose - CORRECT ANSWER A. loperamide- indicated for nonspecific diarrhea but should be avoided if gross bloody stool or temp above 101 degrees or if C. diff expected. 4mg initially, then 2mg after each loose stool, NTE 16mg/day. When utilizing the SPIRIT pneumonic, as a spiritual assessment tool for a hospice patient, the first question to ask for "S" part is: A. does spirituality play a part in your personal life? B. restrictions that affect healthcare decisions? C. how does faith affect how you feel about death? D. do you have a normal religious affiliation? - CORRECT ANSWER D. Spiritual: formal religious affiliation? Personal: practices/beliefs, daily life? Integration: spiritual community Ritual: specific practices that affect healthcare Implication: aspects of care to keep in mind Terminal events: does faith affect feelings about death? Obese patient, diabetes; underwent surgery for bowel obstruction 6 days ago and has persistent N/V. Feels "popping" sensation at incision site-->intestinal evisceration. Initial response: A. administer opioid, no intervention B. semi-fowler's knees up, notify surgeon C. explain what is happening, ask for guidance D. supinate patient, cover with dry sterile gauze - CORRECT ANSWER B. INITIAL RESPONSE: notify surgeon Next- cover sterile soaked gauze, IV site, O2 76 year old female, generally good health, new pathologic fracture of proximal femur. pt states it occurred while walking- most likely cause: A. abuse B. multiple myeloma C. osteoporosis D. bone cyst - CORRECT ANSWER C. osteoporosis- DEXA scan gold standard; T- score -2 indicates osteoporosis When collaborating with patient and family on POC, it's important for them to understand: A. rights and responsibilities B. limitations C. organizations philosophy D. difference between goals and objectives - CORRECT ANSWER A. rights and responsibilities- ask them what goals and expectations are, what is important to them Native American patient, stage IV multiple myeloma, on hospice in extended care facility. Reportedly little pain AEB does not request medicine but does lay in fetal position and refuses food and fluids. APRN should advise nursing staff: A. pt probably comfortable without pain medication B. pt may avoid outward expressions of pain C. staff nurse should be more aware of pt needs D. pt probably prefers to suffer than take medications - CORRECT ANSWER B. pt may avoid outward expressions of pain, but his body language indicates otherwise D. applying absorptive dressings with cellulose fibers - CORRECT ANSWER B. apply pouch such as hollister wound manager- change Q4-7 days A female patient who has undergone surgery, radiotherapy, and chemotherapy for breast cancer has lost her hair but states she cannot afford to buy a wig. Which organization can you refer to for financial assistance? A. songs of love foundation B. assoc of cancer online resources C. cancer care D. american cancer society - CORRECT ANSWER D. American Cancer Society According to the American Geriatrics Society Guideline for the Prevention of Falls in Older Persons, if a patient has had one fall in the previous year: A. the patient should be assessed for gait and balance B. no further assessment is needed C. a full assessment including vision, joint function, mental status, neuro status should be carried out D. refer to geriatric specialist - CORRECT ANSWER A. Assess for gait and balance including the Get up and Go Test. Only multiple falls should elicit a full assessment If a patient receiving abdominal radiation has 7-9 loose stools daily with severe cramping and some incontinence, according to the National Cancer Institute Scale of Severity of Diarrhea, the pts score would be: A. 1 B. 2 C. 3 D. 4 - CORRECT ANSWER C. 3 Score 0: normal stools Score 1: 2-3 above normal, no other sx Score 2: 4-6 above normal, nocturnal, abd cramps Score 3: 7-9 above normal, severe cramping/ incontinence Score 4: 10+ above normal, grossly bloody stools, need for parenteral support A palliative care patient with MS is increasingly immobile and spends most of the time in bed. Which of the following scores (range 6-23) on the Braden Scale is the breakpoint for risk of pressure ulcer? A. less than 8 B. less than 12 C. less than 16 D. less than 18 - CORRECT ANSWER C. Less than or equal to 16 Score of 23 indicates minimal risk and 6 indicates a strong likelihood of developing pressure ulcers. A 68 year old patient has appeared depressed so APRN assesses using Geriatric Depression Scale which comprises 15 questions. How many "yes" answers are needed to indicate depression? A. 4 B. 6 C. 8 D. 12 - CORRECT ANSWER B. 6 yes answers indicate depression. Tool can be used with normal cognition and mild to moderate cognitive impairment. When conducting the H&P of a military veteran who served in Vietnam, which concern applies to this specific group of vets? A. PTSD B. Shrapnel injuries C. Substance abuse D. Agent Orange - CORRECT ANSWER D. Agent Orange- known teratogenic effects including leukemia and Hodgkins lymphoma, type 2 DM, ischemic heart disease, parkinson's, peripheral neuropathy. If a dying person tells you she has been seeing her mother who is deceased for many years, what is the appropriate response? A. Does seeing your mother comfort or frighten you? B. You're just dreaming C. I'm sure your mother is watching over you D. It's probably because of the medicine - CORRECT ANSWER A. Does seeing your mother comfort or frighten you? Which of the following unique needs may need to be addressed in the POC for homeless patients? A. fall and dysphagia precautions B. PTSD C. lice and malnutrition D. drug seeking behaviors - CORRECT ANSWER C. Lice and malnutrition Patient who completed a course of mantle radiation for Hodgkins disease 20 yrs ago has developed increasing weakness and SOB on exertion. Because of previous radiation, patient is especially at risk for: A. pancreatic CA B. breast and lung CA C. liver CA D. colon and rectal CA - CORRECT ANSWER B. breast and lung cancer- pts with Hodgkins have 17% risk of developing another malignancy including increased risk of leukemia with onset often within 4 years APRN started support group for pts with Parkinsons to help with coping and delay progression. APRN is facilitator, this type of preventive program is: A. primary B. secondary C. tertiary D. quaternary - CORRECT ANSWER C. Tertiary Primary- prevent disease occurrence (no smoking, seatbelts, vaccinations) Secondary- identify and reduce impact (screenings, BP) Tertiary- prevent/delay disease progression 17 yr old with AIDS and pneumonia is medically unstable and his parents have broached the topic of EOL decisions with him; pt refusing to discuss the issue stating he is "not going to commit suicide". APRN advises parents to: A. remain supportive and wait for pt readiness to discuss EOL B. explain difference between EOL decisions and suicide C. urge the pt to participate in some decision making D. tell the pt they will make the decisions for him - CORRECT ANSWER A. Remain supportive and wait for patient readiness to discuss EOL. 15 yr old pt with leukemia tells APRN that she wants to fill out a living will so her parents will not have to make EOL decisions for her. A document appropriate for adolescent patients: A. Five Wishes B. Voicing My Choices APRN notes a team member usually prefers to work alone and makes excuses for not delegating more of his workload. The team member frequently takes overtime shifts when the unit is shorthanded but is increasingly short tempered and c/o fatigue and headaches. The team member is likely to experience: A. burnout B. advancement C. ostracism D. injury - CORRECT ANSWER A. Burnout When educating an 80 yr old pt about self care and pain control, the teaching strategy most useful is to: A. review study skills B. allow ample time for learning and practicing C. utilize role-playing D. utilize problem-centered learning - CORRECT ANSWER B. Allow ample time for learning and practicing. Also spending time getting to know the patient, eliminating non-essential info, remain patient and supportive, provide written materials. APRN has accepted a position in a different hospital and is in the "being" stage of role transition after 6 months. This stage is characterized as: A. emotional lability and recognition of limitations B. acceptance of the new role C. increase in knowledge and self-doubt D. limited problem solving skills - CORRECT ANSWER C. Being stage Doing (3-4 mo)- transition shock with emotional lability and self doubt. problem solving limited. Being (4-5 mo)- transition crisis, knowledge increases along with self-doubt; stress but increased awareness, feeling unprepared for clinical situations Knowing (3-4 mo)- acceptance of the new role and recovering from some of the problems and stresses of earlier stages A pt with COPD is recovering from PNA and has spent much of the day in bed with curtains drawn and appears to have been crying. The most appropriate response is: A. you seem upset B. why are you crying C. please tell me what is bothering you D. i'm sure everything will be ok - CORRECT ANSWER A. You seem upset- this is the most empathetic response, recognizes feelings without prying. Allows pt time to respond. When the APRN(sender) is talking (transmission) and giving information (message) to a patient (recipient), communication is most dependent on the: A. situation B. sender C. message D. recipient - CORRECT ANSWER D. Recipient must be motivated to receive the message and must have no barrier like hearing impairment or emotional upset that interferes with the transmission. Ability to comprehend then depends on many complex factors. barrier to effective communication: A. nervous and speaks high pitch B. cheerful voice C. rubs hands together when speaking D. leans toward patient when speaking - CORRECT ANSWER communication style includes "I" statements and asks for opinions such as "How do you feel about that?" is: A. passive B. aggressive C. neutral D. assertive - CORRECT ANSWER rifampin - CORRECT ANSWER alleviates pruritus in liver disease- also could use dronabinol, UVB therapy, naloxone initial treatment for chronic mild to moderate osteoarthritis - CORRECT ANSWER acetaminophen 4g/day; avoid NSAIDs if possible only for severe pain; intraarticular injections for refractory cases opioid induced constipation - CORRECT ANSWER combo stimulant and stool softener; avoid bulk laxatives if poor fluid intake signs/sx of intestinal obstruction from cancerous lesion at duodenum - CORRECT ANSWER copious amounts of undigested food emesis, splashing sounds in LUQ, generally absence of pain or distension pleurX catheter drain limit at home - CORRECT ANSWER 2000cc consideration of lymphadema s/p mastectomy - CORRECT ANSWER infection control (most common complication)- examine arm often, avoid lab draws, tight clothing pressure ulcer dressing overview - CORRECT ANSWER Hydrogel- good for small drainage, NOT large amounts etoh clearance - CORRECT ANSWER 20mg/dL per hour Ex. 70kg patient with BAC 140mg/dL would take approx 7 hours to metabolize alcohol NYHA classification - CORRECT ANSWER I- essentially asymptomatic during normal activity, good prognosis II- sx w/some exertion, usually absent at rest, good prognosis III- obvious limitations, discomfort on any exertion, fair prognosis IV- sx at rest, poor Peripheral atertial disease presentation - CORRECT ANSWER pain range intermittent to severe constant, pedal pulses generally weak or absent, foot may be rubor on dependency and pale on elevation; skin pale, shiny, cool, edema usually absent or minimal assessing perfusion of LE - CORRECT ANSWER venous occlusion greater than 20 seconds ABI scoring - CORRECT ANSWER > 1.3- abnormally high 1-1.1 normal, asymptomatic <0.95 narrowing of 1+ leg blood vessels anticholinergics (scopolamine td) - CORRECT ANSWER ICP induced nausea, GI obstruction, excess GI secretions antihistamines (diphenhydramine) - CORRECT ANSWER ICP induced nausea, vestibular, GI obstruction benzos/antiemetic - CORRECT ANSWER general and anxiety induced nausea butyrophenones (haldol) - CORRECT ANSWER mechanical and opioid induced nausea cannibinoids - CORRECT ANSWER chemo induced nausea 5 HT-3 receptor antagonists (ondansetron) - CORRECT ANSWER chemo, radiation, post op nausea octreotide - CORRECT ANSWER GI obstruction phenothiazines (prochlorperazine) - CORRECT ANSWER general nausea prokinetic agents (metoclopramide) - CORRECT ANSWER - Used for gastroparesis (when the stomach moves slowly or not at all), GERD (short-term), post-op n/v, opioid- chemo- radiation-induced nausea - Stimulates gastric motility without increasing secretions - AEs: extrapyramidal symptoms - Contraindications: pts taking anticholinergic meds, CNS depressants steroids (dexamethasone) - CORRECT ANSWER frequently used with other antiemetics to potentiate their effects Steps to opioid conversion - CORRECT ANSWER 1. determine 24 hour dose 2. calculate equianalgesic dose 3. decrease dose of new med by 25-50% initially if sx controlled 4. increase 100-125% OR rotate opioids if sx NOT controlled adverse effects of radiation - CORRECT ANSWER fatigue, local skin irritation, burns, hair loss, GI upset, dysuria, depressed immune system, anemia "cancer diets" - CORRECT ANSWER idea- some foods "feed" cancer; basic concepts: avoid refined carb and milk avoid fatty, fast, processed avoid etoh, caffeine, nicotine, chemicals avoid meats avoid overcooking utilize organic when able raw foods encouraged radiation induced nausea - CORRECT ANSWER ondansetron 30 min prior to treatment tumor lysis syndrome - CORRECT ANSWER Chemotherapy can cause massive destruction of cells leading the creation of uric acid which can be toxic to the kidneys leading to Acute Tubular Necrosis. TNM staging of HCC - CORRECT ANSWER T= primary tumor N= regional lymph node M= distant mets X= cannot assess 0= not evident 1-4= increasing size, number, extent Example: stage IIIB, T3, N1, M0= solitary tumor with vascular invasion, regional lymph node mets, no distant mets xerostomia - CORRECT ANSWER decreased saliva production and dry mouth; Tx=pilocarpine, ADRs increased sweating, nausea, flushing, cramping good mouth care most important substituted judgement - CORRECT ANSWER form of surrogate decision making where the surrogate attempts to establish what decision the patient would have made if that patient were competent to do so Peplau's four levels of anxiety - CORRECT ANSWER Mild: seldom a problem Moderate: perceptual field diminishes Severe: perceptual field is so diminished that concentration centers on one detail only or on many extraneous details Panic: the most intense state Types of Grief - CORRECT ANSWER Uncomplicated- ability to move toward acceptance of the loss Complicated- severe in longevity, affects daily function -Chronic- disbelief the loss is real -Masked- physical sx or other negative behaviors out of character -Delayed- feelings postponed Disenfranchised- minimized significance by others (ie coworker, pet, ex spouse) Anticipatory- starts at dx, pre-death often interventional analgesia - CORRECT ANSWER epidural- efficacy affected by catheter placement and med choice intrathecal- single injection can last 24 hrs, pump 6 months nerve block- intractable/severe pain LVAD discontinuation considerations - CORRECT ANSWER pt usually sedated to reduce the perception of dyspnea associated with abrupt reduction in cardiac output- in most cases pt will die within minutes neutropenia - CORRECT ANSWER disease or treatment cause, increased risk for infection 1000- high risk, 500- severe risk neutropenia + fever= broad spec abx, risk for fungal superinfection avoid fresh flowers, unpeeled fruits, HEPA filter mask, body/oral hygiene critical SVC syndrome - CORRECT ANSWER blockage like tumor or thrombosis reduces blood flow sx- edema, headache, dizziness, cough, flush, venous distension tx- steroids, diuretics nociceptive (somatic, visceral) - CORRECT ANSWER usually localized