NURS 361 MIDTERM, FINAL EXAM, AND PRACTICE EXAM 2024 | ALL QUESTIONS AND CORRECT ANSWERS, Exams of Nursing

Download NURS 361 MIDTERM, FINAL EXAM, AND PRACTICE EXAM 2024 | ALL QUESTIONS AND CORRECT ANSWERS and more Exams Nursing in PDF only on Docsity! NURS 361 MIDTERM, FINAL EXAM, AND PRACTICE EXAM 2024 | ALL QUESTIONS AND CORRECT ANSWERS | GRADED A+ | VERIFIED ANSWERS | LATEST VERSION NURS 361 MIDTERM Liz has a large number of sources to contact to obtain educational materials for her clients to use to plan programs to decrease alcohol abuse. Appropriate sources include all of the following except: A. A nearby university B. Government agencies such as the CDC and Alcohol, Drug, and Mental Health Agency C. Media advertising specialists D. Nonprofit organizations such as alcoholics anonymous E. A regional hospital's substance abuse programs ------CORRECT ANSWER---------------C A locality-based entity, composed of systems of formal organizations reflecting societal institutions, informal groups, and aggregates that are interdependent and whose function or expressed intent is to meet a wide variety of collective needs ------CORRECT ANSWER---------------Community Services (utilization review-process to determine necessity of treatment). Ex: BRCA + = Mastectomy? ------CORRECT ANSWER--------------- Structural dimension Effective function-identify needs/solutions. Participation/action. Achieve working consensus on goals and priorities. Ex: domestic violence victims --- ---CORRECT ANSWER---------------Process dimension Physical (rates, life expectancy, risk factors). Emotional (consumer satisfaction). Social (crime rates) ------CORRECT ANSWER--------------- Status dimension Increasing the number of police in high crime neighborhood is an example of what community health dimension: A. Status B. Structural C. Process ------CORRECT ANSWER---------------B Assessment is one of the three core functions of public health nursing. What are the other 2? A. Assurance and Policy Development B. Status and Process C. Advocacy and Disease Investigation D. Implementation and Evaluation ------CORRECT ANSWER---------------A What facilitates learning and emphasizes the provision of knowledge and skills? Dissemination of instruction. ------CORRECT ANSWER--------------- Education What emphasizes the receipt of knowledge and skills and results in behavioral changes? What is retained ------CORRECT ANSWER-------------- -Learning Double blind studies are used to reduce what? ------CORRECT ANSWER-- -------------Bias Group of people ------CORRECT ANSWER---------------Cohort studies Ex: looking at individuals with lung cancer or individuals who smoke and seeing if they develop lung cancer over-time ------CORRECT ANSWER----- ----------Cohort studies Ex: matching different variables. Hormone replacement therapy with breast cancer patients. Same variable demographics. Comparing one group to another group. ------CORRECT ANSWER---------------Case control studies Ex: individual family, common experience, narrative. Reporting on individual case ------CORRECT ANSWER---------------Case reports Nurse Cindy wants to know the effect of alcohol consumption on the development of breast cancer in women age 20-45 by comparing those women that consume 1 or more drinks per day to those that do not. This is an example of what kind of study: A. Cohort B. Case Report C. Randomized Clinical Trial D. Case-Control ------CORRECT ANSWER---------------D A method of identifying, appraising, and synthesizing research evidence with the aim of evaluating and interpreting all available research that is relevant to a particular research question. Ex: exhaustive summary of the literature-PICO ------CORRECT ANSWER---------------Systematic review A specific method of systematic review, where the results of several studies are quantitatively combined and summarized. Ex: tv viewing and BMI's. Does less tv viewing result in lower BMI's in kids? ------CORRECT ANSWER---------------Meta-analysis Nurse Ben conducts a thorough database search critically analyzing the evidence to determine the barriers to health care access experienced by Hispanics living in Champaign County. This is an example of: A. Meta-Analysis B. Systematic Review ------CORRECT ANSWER---------------B (minimizing bias) Interviewer bias (no script) selection bias (chose participant to skew results) generalizing where not applicable how was data collected and protected ------CORRECT ANSWER-------------- -Quality number of studies magnitude of effect (power) sample size ------CORRECT ANSWER---------------Quantity similar findings using similar and different study designs validity (accuracy) reliability (consistency) ------CORRECT ANSWER---------------Consistency What are the three domains for evaluation systems that grade the strength of evidence? ------CORRECT ANSWER---------------Quality, quantity, and consistency Accuracy ------CORRECT ANSWER---------------Validity Consistency ------CORRECT ANSWER---------------Reliability Comprises those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations." ------CORRECT ANSWER---------------Environmental Health Housing, climate, political structures, etc. ------CORRECT ANSWER---------- -----Habitat Characteristics of population that determine health status and disease susceptibility include: gender, age, genetics, herd immunity, etc. ------ CORRECT ANSWER---------------Population factors Health-related beliefs and behaviors. Choice to smoke, use of drugs, or wear a seat belt ------CORRECT ANSWER---------------Behavioral factors Carbon Monoxide, Nitrogen Oxides, Hydrocarbons, Particulate Matter, Sulfur Dioxide and Lead ------CORRECT ANSWER---------------6 major pollutants True or False? The mission of public health is social justice, which entitles all people to basic necessities such as adequate income and health protection and accepts collective burdens to make this possible ------CORRECT ANSWER---------------True What is a group or collection of locality based individuals, interacting in social units and sharing common interests, characteristics, values and/or goals, resources, and the environment? ------CORRECT ANSWER----------- ----Community What is a collection of individuals who have one or more personal or environmental characteristics in common? Members of a community typically belong to many various populations or subpopulations ------ CORRECT ANSWER---------------Aggregate Which of the following is an example of an aggregate or population? A. Students in a county school system B. A U of I nursing student providing H1N1 immunizations. C. A patient in the intensive care unit at the local hospital D. People who have seen the movie Titanic ------CORRECT ANSWER------ ---------A What is the goal of Healthy People 2020? ------CORRECT ANSWER--------- ------Increase quality of life What year did public health changes - gains in life expectancy? Attributed to improvements in sanitation, water and food safety, control of infectious diseases, and immunizations? ------CORRECT ANSWER---------------1900 In 1997, IOM published "Improving Health in the Community: Role for Performance Monitoring" which challenged communities to identify local health indicators and develop a plan to improve the health status of residents. What was the result? ------CORRECT ANSWER--------------- IPLAN What is a document that guides what we do for public health? ------ CORRECT ANSWER---------------IPLAN What are the three key roles of public health practice? The core functions -- ----CORRECT ANSWER---------------Assessment, policy development, and assurance What is systematic data collection on the population, monitoring of population's health status, making information available on health of community? •Windshield Survey, CDC Reports, Mortality and Morbidity Data ------ CORRECT ANSWER---------------Assessment What is the need to provide leadership in developing policies that support the health of the population, including using scientific knowledge in making decisions about policy? •Laws, Clean Air and Water Act, Health Care Reform ------CORRECT ANSWER---------------Policy development What is the role of public health in making sure that essential community- oriented health services are available; may include providing essential health services for those who would otherwise not receive them? Also ensures a competent public health and personal health care workforce is available. •Skilled staff, provision of quality services ------CORRECT ANSWER--------- ------Assurance •Monitor health status to identify community health problems. •Diagnose and investigate health problems and health hazards in the community. •Research for new insights and innovative solutions to health problems. ---- --CORRECT ANSWER---------------Assessment •Inform, educate, and empower people about health issues. •Mobilize community partnerships to identify and solve health problems. •Develop policies and plans that support individual and community health efforts. •Research for new insights and innovative solutions to health problems. ---- --CORRECT ANSWER---------------Policy Development •Enforce laws and regulations that protect health and ensure safety. •Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Dietary instructions and monitoring for family with overweight members ----- -CORRECT ANSWER---------------Tertiary prevention What type of prevention? Birthing classes for pregnant teenage mothers AIDS and other STD education for high school students ------CORRECT ANSWER---------------Primary prevention What type of prevention? Vision screening of second grade class Mammography van for screening of women in a low-income neighborhood Hearing tests at a senior center ------CORRECT ANSWER--------------- Secondary prevention What type of prevention? Shelter and relocation centers for fire or earthquake victims Emergency medical services Community mental health services for chronically mentally ill Home care services for chronically ill ------CORRECT ANSWER--------------- Tertiary prevention The Elizabethan Poor Law of 1601 is similar to which of the following current laws? A. HIPPA B. Medicaid C. Medicare D. ADA ------CORRECT ANSWER---------------B Who worked during the Crimean War? ------CORRECT ANSWER------------- --Florence Nightingale Who established Henry Street Settlement in 1893 (along with Mary Brewster)? ------CORRECT ANSWER---------------Lillian Wald Who played an important role in establishing public health nursing in U.S.— later called "Visiting Nurses Association of NYC"? ------CORRECT ANSWER---------------Lillian Wald Who found that illness was not always the main reason for absence? ------ CORRECT ANSWER---------------Lina Rogers Who was the first U.S. school nurse? ------CORRECT ANSWER--------------- Lina Rogers Pediculosis ------CORRECT ANSWER---------------Head lice What funded opportunities for education and employment of PHNs? ------ CORRECT ANSWER---------------Social Security Act of 1935 What funded assistance to states, counties, and medical districts in establishing adequate health services? ------CORRECT ANSWER------------ ---Social Security Act of 1935 What provided funds for research and investigation of disease? ------ CORRECT ANSWER---------------Social Security Act of 1935 What established state and local community health departments and training of personnel requirements? ------CORRECT ANSWER--------------- Social Security Act of 1935 What year were Medicare and Medicaid written into the act? ------ CORRECT ANSWER---------------1965 Threats to health from communicable diseases, the environment, chronic illness, and the aging process have changed over time. The newer threats to health in the United States that community health nurses are currently faced with include: A. Diphtheria, cholera, and typhoid fever B. HIV, AIDS, and bioterrorism C. Plague and pneumonia D. Polluted water and air, poor sanitation ------CORRECT ANSWER---------- -----B The approximate percentage of each health care dollar spent on public health services is: A. 3% B. 10% C. 25% D. 50% ------CORRECT ANSWER---------------A B. Multilateral C. Non-Governmental D. Both A and B ------CORRECT ANSWER---------------D Framework that originated in the 1990s trough the Minnesota Department of Health ------CORRECT ANSWER---------------Intervention Wheel Public health nurses intervene at all levels of practice. What are these? a. Community, Outreach, Individual b. Systems, Informatics, Community c. Community, Systems, Individual d. Assessment, Intervention, Evaluation ------CORRECT ANSWER----------- ----C How many interventions are in the intervention wheel? ------CORRECT ANSWER---------------17 Describes and monitors health events through ongoing and systematic collection, analysis and interpretation of health data for the purpose of planning, implementing and evaluating public health interventions ------ CORRECT ANSWER---------------Surveillance Systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures ------CORRECT ANSWER---------- -----Disease Investigation Locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained ------CORRECT ANSWER--------------- Outreach Identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations ------CORRECT ANSWER--------------- Screening Locates individuals and families with identified risk factors and connects them with resources ------CORRECT ANSWER---------------Case finding Assists individuals, families, groups, organizations and/or communities to identify and access necessary resources to prevent or resolve problems or concerns ------CORRECT ANSWER---------------Referral/Follow-up Optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services ------ CORRECT ANSWER---------------Case Management Direct care tasks a registered professional nurse carries out under the authority of a health care practitioner as allowed by law ------CORRECT ANSWER---------------Delegated Functions Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities. ------CORRECT ANSWER---------------Health Teaching Establishes an interpersonal relationships intended to increase or enhance capacity for self-care and coping with a community, system, and family or individual. ------CORRECT ANSWER---------------Counseling Seeks information and generates optional solutions to perceived problems or issues through interactive problem solving with a community, system, and family or individual ------CORRECT ANSWER---------------Consultation Commits two or more persons or an organization to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. ------CORRECT ANSWER--------------- Collaboration Promotes and develops alliances among multiple organizations or constituencies for a common purpose ------CORRECT ANSWER-------------- -Coalition Building Helps community groups to identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively have set. ------CORRECT ANSWER---------------Community Organizing Plead someone's cause or act on someone's behalf, with a focus on developing the community, system, and individual or family's capacity to plead their own cause or act on their own behalf. ------CORRECT ANSWER---------------Advocacy The community is assessed in relationship to the environment. ------ CORRECT ANSWER---------------Anderson and McFarlane - 1948 study followed 5209 adults (age 30-60)over lifetime to track risk factor for CHD-ongoing (10 cohorts of relatives of initial participants since) - Identified links to increased BP/cholesterol, smoking ------CORRECT ANSWER---------------Framingham Heart Study - 1965 study followed 6928 individuals over 4 years - Identified links between health/social behaviors to mortality (smoking/excessive alcohol positively linked) ------CORRECT ANSWER---------------Human Population Lab in Alameda County, California Gaseous pollutants, greenhouse effect-trapping of pollutants in ozone, destruction of the ozone layer, aerial spraying of herbicides and pesticides, acid rain -sulfur dioxide and nitrogen oxides from plant emissions combine with rainwater ------CORRECT ANSWER---------------Atmospheric Quality What are the three main water quality examples? ------CORRECT ANSWER---------------Individual waste, sewage, and agriculture waste The availability and volume of the water supply and the mineral content levels, pollution by toxic chemicals, and the presence of pathogenic microorganisms. Consists of the balance between water contaminants and existing capabilities to purify water for human use and plant and wildlife sustenance. ------CORRECT ANSWER---------------Water quality Normal lead level ------CORRECT ANSWER---------------5 mcg/dL What are the 4 more most common water quality issues? ------CORRECT ANSWER---------------Typhoid fever, cholera, food poisoning, hep A The availability, safety, structural strength, cleanliness, and location of shelter, including public facilities and family dwellings ------CORRECT ANSWER---------------Housing Homelessness, fire hazards, rodent and insect infestation, poisoning from lead-based paint. Lead paint used in homes until 1978. Sick building syndrome: toxic pollutants in building materials where people reside or work (mold, asbestos, formaldehyde), unsafe neighborhood crimes ------ CORRECT ANSWER---------------Housing Residual animal antibiotics - contaminated - pass into meats, bacterial food poisoning, food adulteration/flavor enhancers, carcinogenic chemical food additives - irradiation, preservatives, pesticides left on food, more than 350 outbreaks each year 76 million affected annually, 5,000 deaths, 1/6 of US food supply shipped in from 150 countries (1/5 veggies, 1/2 fruit, 80% seafood). Less than 1% is inspected and tested ------CORRECT ANSWER- --------------Food quality threats Intestinal damage, hemolytic-uremic syndrome-kidney failure. Transmission: Undercooked meat, produce (lettuce/spinach), wells ------ CORRECT ANSWER---------------E. Coli Most common - fever, HA, abd pain, diarrhea, N&V. Transmission: Inadequate processing/undercooked meat ------CORRECT ANSWER-------- -------Salmonella Affects nervous system-paralysis/resp failure. Blurred vision, slurred speech, Transmission: home canned foods, baked potatoes. R/t to botox. Can causes respiratory failure. Cause bubbles in canned foods. ------ CORRECT ANSWER---------------Botulism Bloody diarrhea, N&V, abd pain, fever, fatigue, Transmission: fecal-oral route, food workers improper hand washing, sewage on crops ------ CORRECT ANSWER---------------Shigella (Leading cause of bacterial diarrheal illness)- also N &V, abd pain, Transmission: raw poultry, milk, human or animal feces. Collect stool sample ------CORRECT ANSWER---------------Campylobacter The management of waste materials resulting from industrial and municipal processes, human consumption, and efforts to minimize waste production - -----CORRECT ANSWER---------------Waste Control •US produces one ton of waste per person each year •Use of nonbiodegradable plastics-diapers, water bottles •Poorly designed solid waste dumps - leaking into water supply •Inadequate sewage systems •Transport and storage of hazardous waste •Illegal industrial dumping-oil, tires, chemicals ------CORRECT ANSWER---- -----------Waste Control •Example-20% 1st graders BMI ranks in obese range for Heritage school district. Why? ------CORRECT ANSWER---------------Descriptive epidemiology Examines complex relationships among determinants of diseases. The focus is on disease etiology/associations Ex: smoking can cause lung cancer ------CORRECT ANSWER--------------- Analytic Epidemiology Interaction between the host (living organisms), environment (external surroundings) and agent (factor that must be present or lacking for disease to occur) determines the health or risk of disease in the community. ------ CORRECT ANSWER---------------Epidemiological Model susceptible human or animal who harbors and nourishes a disease-causing agent ------CORRECT ANSWER---------------Host a factor that causes or contributes to a health problem or condition ------ CORRECT ANSWER---------------Agent deficiencies Example Vit D-Rickets, Vit A-blindness ------CORRECT ANSWER---------------Nutrient pesticides, radiation, asbestos, sulfur, household ------CORRECT ANSWER---------------Chemical Bacteria, fungi, virus, protozoa ------CORRECT ANSWER--------------- Biologic UV, earthquake, tsunami, flood, volcanic ash, fire ------CORRECT ANSWER---------------Physical Crisis that create stress- divorce, loss ------CORRECT ANSWER-------------- -Psychological longer exposed, higher severity of sx ------CORRECT ANSWER--------------- Duration of exposure Increased dose, higher severity of sx ------CORRECT ANSWER--------------- Dose ability/rate of replication in host. High-Colds Low-Rabies ------CORRECT ANSWER---------------Infectivity severity of disease High-Inhalation Anthrax-75% ------CORRECT ANSWER--------------- Virulence all the external factors surrounding the host that might influence vulnerability or resistance Climate Geography Poverty Culture Access to care ------CORRECT ANSWER---------------Environment Evidence from human studies indicates the presence of causative factors that increase the probability of disease occurrence Ex: smoking is causative factor of Lung Ca ------CORRECT ANSWER------- --------Causal Inference organisms where infectious agent lives and multiplies Humans are a reservoir for HIV, Flu; Birds-West Nile ------CORRECT ANSWER---------------Reservoir immediate transfer of agent from reservoir to host Touching, biting, kissing, sex, fecal-oral, droplet(sneeze, cough, spit, laugh, talk) ------CORRECT ANSWER---------------Direct transmission via air, food, water (vehicle), inanimate objects (fomites), vector (insects) from reservoir to the host ------CORRECT ANSWER---------- -----Indirect inanimate carrier -air, food, water, letter (anthrax) ------CORRECT ANSWER---------------Vehicles and fomites animate carriers -insects. Ex: tick is a vector for Lyme disease ------ CORRECT ANSWER---------------Vectors provides interventions aimed at disability limitation and rehabilitation from disease, injury, or disability ------CORRECT ANSWER---------------Tertiary prevention the precision or reproducibility of a measure (consistency or repeatability). Sources of error can affect the reliability of tests: Variations in the trait being measured Observer variation Inconsistency in the instrument ------CORRECT ANSWER--------------- Reliability probability of correctly classifying an individual with regard to the disease or outcome of interest, usually measured by sensitivity and specificity. Refers to the soundness of the study-does it measure what it purports to measure Can be reliable without being valid but not validity without reliability Accuracy ------CORRECT ANSWER---------------Validity Probability of correctly identifying true positives. You have the disease and it is detected by the screening test. False Negative -Told don't have the disease and really do. Cases of disease are undetected and untreated. If Sensitivity is 84%, False Neg is 16% Example: Preg Test is 89% Sensitive then 11% of people will be told they aren't pregnant when they really are. ------CORRECT ANSWER--------------- Sensitivity Probability of correctly identifying true negatives. You don't have the disease and the test comes back negative for the disease so the test is accurate. False Positive -Told you have the disease and you really don't. Could result in unnecessary treatments, psychological distress of falsely being told you have the disease, increased costs of tests/procedures If Specificity is 75%, False Pos is 25%. Example Mammograms Specificity is 64-97%. So 36-3% of people are told they have positive finding when there is no finding. ------CORRECT ANSWER---------------Specificity A mom brings her 7-year-old in to see the doctor for a sore throat. A new test for detecting strep throat has just come out. Its sensitivity is 99% and its specificity is 75%. The test comes out positive. Does he really have strep? A. Yes B. No ------CORRECT ANSWER---------------A, B the systematic collection, analysis, and interpretation of data related to the occurrence of disease and the health status of a given population (i.e., reporting communicable diseases). ------CORRECT ANSWER--------------- Surveillance Public health uses ____ to assess and prioritize the health needs of populations, design public health and clinical services to address those needs, and evaluate the effectiveness of public health programs ------ CORRECT ANSWER---------------Surveillance •Observe and describe conditions in a population (person/place/time or Who, What, Where and When). Provides hypothesis for further testing •Counts (vital stats) and rates (prev/incidence) ------CORRECT ANSWER--- ------------Descriptive epidemiology •Cross Sectional studies (Prevalence)-patterns at a given time. Ex-HTN- Take everyone's BP today •Case-control studies •Compare those with the disease (cases) and those without (controls). Match variables-age, race, ethnicity.. •Cohort studies-longitudinal-condition over time •Most expensive and time consuming ------CORRECT ANSWER--------------- Analytic epidemiology •Builds on descriptive and analytic approaches and controls or changes the factors suspected of causing the health condition ------CORRECT ANSWER---------------Experimental studies What are the three essential components of experimental studies? ------ CORRECT ANSWER---------------Manipulation, control, and randomization Passed from one person to another. Infectious agent: source (reservoir) --> host ------CORRECT ANSWER---------------Communicable Disease What is the leading cause of death in the US? ------CORRECT ANSWER--- ------------Chronic diseases What remain among the 10 leading causes of death, and, in the twenty-first century, infectious diseases have become a means of terrorism. ------ CORRECT ANSWER---------------Flu and pneumonia Immunity to one agent provides immunity to another related agent Hep B and D; Cowpox and Smallpox. You get Hep B so then you're protected against Hep D so COMBINATION ------CORRECT ANSWER------ ---------Cross immunity Population Group 80% = higher-greater production, less exposure Immunity level in a population group indicating resistance to invasion More individuals that are disease resistant, the higher the herd immunity. -- ----CORRECT ANSWER---------------Herd immunity Parent to offspring (placenta or breast milk) ------CORRECT ANSWER------- --------Vertical transmission Person to person or animal to person spread by: direct, airborne, indirect --- ---CORRECT ANSWER---------------Horizontal transmission True or False? Exposure to an infectious agent does not always lead to an infection, and infection does not always lead to disease. ------CORRECT ANSWER--------- ------True The interval between invasion by an infectious agent and the first appearance of signs and symptoms of disease. 24-48 hours after ------ CORRECT ANSWER---------------Incubation period Refers to the interval during which an infectious agent may be transferred directly or indirectly from an infected person to another person. 7 days after symptoms develop ------CORRECT ANSWER---------------Communicable period Levels at which a disease/infectious agent is habitually present in a geographic area, but outbreaks are contained to a minimum. Ex: chicken pox/pertussis, malaria (Africa) ------CORRECT ANSWER--------------- Endemic Disease occurrence that clearly exceeds the normal or expected frequency in a community Ex: one case of smallpox, outbreak of gastroenteritis in a nursing home. Strep throat or measles in a school where 1/3 of pop is affected. ------CORRECT ANSWER---------------Epidemic An epidemic that's distribution is worldwide (1918 influenza killed 20-40 million - spread to North America, Europe, Asia, Africa, Brazil and the South Pacific). H1N1 - 61 million cases in US, 274,000 hospitalizations, 12,470 deaths ------CORRECT ANSWER---------------Pandemic Widespread use of antibiotics ------CORRECT ANSWER--------------- Healthcare access Deforestation, urbanization ------CORRECT ANSWER--------------- Environmental changes Reduction in personnel, prevention programs ------CORRECT ANSWER---- -----------Public Health Sexual behavior, drug use, diet ------CORRECT ANSWER--------------- Human Behavior •a specific disease has ceased to be a public health threat •Control of whopping cough, salmonella or ecoli outbreaks ------CORRECT ANSWER---------------Control Which disease is the only known eradicated disease? ------CORRECT ANSWER---------------Small pox •Disease has been interrupted in a defined geographic area (less than 1 case per 1 million population) •Neonatal Tetanus and Polio ------CORRECT ANSWER--------------- Elimination Interruption of person-to-person transmission and limitation of the reservoir of infection such that no further preventive efforts are required ------ CORRECT ANSWER---------------Eradication Ex: CDC, out break of diseases, reportable disease guidelines ------ CORRECT ANSWER---------------Surveillance What is one for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control of disease? ------CORRECT ANSWER---------------Reportable disease INCUBATION PERIOD: 10-12 days. Rash onset typically 14 days after exposure. COMMUNICABLE PERIOD: 4 days before rash to 4 days after rash appears Caused by rubeola virus, Transmission by inhalation or direct contact with nasal/throat secretions Infection with ______ confers lifelong immunity. Treatment-bed rest, fluids Direct and indirect transmission ------CORRECT ANSWER--------------- Measles Virus causes a mild febrile disease with enlarged lymph nodes and a fine, pink rash that is often difficult to distinguish from measles or scarlet fever and is only moderately contagious. Transmission by inhalation or direct contact with respiratory secretion person to person INCUBATION PERIOD: 12-23 days COMMUNICABLE PERIOD: 7 days before rash to 7 days after rash appears In 1941 the link between maternal ___ and poor pregnancy outcomes (intrauterine death, spontaneous abortion, and congenital rubella syndrome [CRS]) was recognized. Occurs in 90% of infants born to + mothers. CRS-cataracts, glaucoma, microcephaly, low IQ By 2005 rubella was no longer endemic in the US ------CORRECT ANSWER---------------Rubella Caused by the bacterium Bordetella pertussis Begins as a mild upper respiratory tract infection, progressing to an irritating cough that within 1 to 2 weeks becomes paroxysmal and is highly contagious. Pertussis is considered endemic in the US. INCUBATION PERIOD: 7-10 days COMMUNICABLE PERIOD: Onset of Sx to 3 weeks. 5 days after treatment. The drug treatment of choice is erythromycin. Neither natural infection nor immunization results in permanent immunity. Nurses may expect periodic outbreaks of pertussis because of its cyclical nature. DTaP given 2, 4, 6, 15-18 months, 4-6 years. TDAP given as adolescent, adult. ------CORRECT ANSWER---------------Pertussis (whooping cough) Viral respiratory infection often indistinguishable from the common cold or other respiratory disease. Three types of influenza viruses: A, B, and C. Type A is responsible for large epidemics. Types B and C are relatively stable viruses, but type A is constantly changing. This results in epidemic outbreaks every few years and pandemic outbreaks every 10 to 40 years. 36,000 deaths annually. 89-90% over age 65 Vaccine supply based on best possible prediction of what type and variant of virus will be most prevalent that year. Yearly immunization is required. Covers for 2 strains of A and 1 B. INCUBATION PERIOD: 1-5 days COMMUNICABLE PERIOD: Day before sx to 1 week after Amantadine and Rimantadine provide effective chemoprophylaxis against type A but not type B influenza. Avian influenza (type A virus H5N1)-close monitoring necessary. Rare cases of human to human ------CORRECT ANSWER---------------Influenza Results from bacteria or from viral or parasitic infection of food such as Salmonella, Campylobacter, hepatitis A, and toxoplasmosis. ------ CORRECT ANSWER---------------Food infection Results from toxins (botulism, mercury poisoning, and paralytic shellfish poisoning) produced by bacterial growth; chemical contaminants (heavy metals); and a variety of disease-producing substances found in certain foods, such as mushrooms and some seafood. ------CORRECT ANSWER-- -------------Food intoxication Usually enter water supplies through animal or human fecal contamination and frequently cause enteric disease. ------CORRECT ANSWER-------------- -Waterborne pathogens What is the most well known waterborne viral agent? ------CORRECT ANSWER---------------Hep A True or False? The most important waterborne bacterial diseases are cholera, typhoid fever, and bacillary dysentery. ------CORRECT ANSWER---------------True Most common vector-borne disease in the United States Transmitted by ixodid ticks that are associated with white-tailed deer and the white-footed mouse Fever, HA, fatigue. Bull's eye skin lesion (3-30 days after bite). May progress to neuro/cardiac Tx: tetracycline or penicillin Wear protective clothing/Prompt tick remova ------CORRECT ANSWER----- ----------Lyme disease Transmitted via Dermacentor tick vector Clinical signs include sudden onset of moderate to high fever, severe headaches, chills, deep muscle pain, and malaise. RMSF responds readily to tetracycline, and one attack confers lifelong immunity. ------CORRECT ANSWER---------------Rocky Mountain spotted fever Caused by the bloodborne parasite Plasmodium and is a potentially fatal disease characterized by regular cycles of fever and chills. ______ individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers. ------ CORRECT ANSWER---------------Elderly LGBTQ ____ populations have the highest rates of tobacco, alcohol, and other drug use ------CORRECT ANSWER---------------LGBTQ The ____ of family is changed over time ------CORRECT ANSWER----------- ----Structure True or False? Traditional nuclear family model is not the only "right" model ------ CORRECT ANSWER---------------True A dynamic, changing, relative state of well-being, which includes the biological, psychological, spiritual, sociological, and cultural factors of a family system ------CORRECT ANSWER---------------Family health Individual in context of family influences. "Why do you smoke?" ------ CORRECT ANSWER---------------Family as the context Sum of individuals. Member choices. We are working with the entire family. Individual influence on family ------CORRECT ANSWER---------------Family as the client Interaction between members. Siblings disagreeing over DNR for parent --- ---CORRECT ANSWER---------------Family as the system Looking at them as the primary unit of society. What is the family's view on drug use or teen pregnancy? Societal values and beliefs ------CORRECT ANSWER---------------Family as a component When asking, "What has changed between you and your spouse since your child's head injury?" the nurse is using the focus of family as: A. The context B. The Client C. A system D. A component of society ------CORRECT ANSWER---------------C Family composition, gender, rank order, functional subsystem, and boundaries ------CORRECT ANSWER---------------Internal structure Extended family and larger systems (including work, health, and welfare) --- ---CORRECT ANSWER---------------External structure Emotional, verbal, nonverbal, and circular communication; problem solving; roles; influence; beliefs; alliances; and coalitions ------CORRECT ANSWER---------------Expressive functioning The family as a unit (the system) interacts with larger units outside the family (suprasystem) and with smaller units inside the family (subsystem) -- ----CORRECT ANSWER---------------General Systems Theory Outside of the family ------CORRECT ANSWER---------------Suprasystem Parent and child relationship ------CORRECT ANSWER--------------- Subsystem Alterations in Family Development: divorce and remarriage ------CORRECT ANSWER---------------Family developmental and life cycle theory •Focuses on the family as a unit of interacting personalities/examines communication by which family members relate to one another •Members judge their own behavior by what they see and hear others do. •The major strength of the approach is the focus on internal processes within the families, such as role, conflict, status, communication, stress response, decision making, and socialization. •Major weaknesses -Views families as closed systems-little interaction/influence with suprasystems ------CORRECT ANSWER------------ ---Interaction Theory The theory that focuses on common tasks of family life and provides a longitudinal view of the family life cycle is: A. Systems B. Structure-Function C. Developmental D. Interactionist ------CORRECT ANSWER---------------C What is a dynamic, systematic, clinical reasoning process that focuses on the outcome of care (Pesut and Herman, 1999). Building on the traditional nursing process model, OPT emphasizes organizing care around the aggregate or community ------CORRECT ANSWER---------------Situational crisis •Family history (genetics)-cardiovascular disease, cancer, asthma, diabetes •Age - osteoporosis, STDs/substance use •Genogram ------CORRECT ANSWER---------------Biological and age related risk •Neighborhood, Poverty, crime, social supports •Ecomap •Nurses connect family to resources-WIC/Medicaid ------CORRECT ANSWER---------------Environmental/social risk •Personal Health habits/behaviors •Education, Counseling, Treatment to Resolve •Example wear seat belt, smoking cessation, exercise ------CORRECT ANSWER---------------Behavioral risk The genogram is an effective technique for assessing which of the following family risks? A. Genetic linkages for BRCA gene B. Tying high juvenile crime rates to lack of after school programming C. Inability to meet family needs due to recent job loss D. Limited access to mental health providers to treat family members diagnosed with depression ------CORRECT ANSWER---------------A Purpose: Give a more accurate assessment of family structure, home environment and behavior in this environment Advantages: Easier to identify barriers and supports for health promotion, relaxed environment Client convenience, client control of setting, eliminate client need for transportation Disadvantages: Cost to home visit agency (additional staff time, gas) Double Documentation ------CORRECT ANSWER---------------Home visits During the initial home visit, which nursing action is most important to include? A. Explore the client's ideas and perceptions about the purpose of the visits. B. Identify with the client the contradictions in the client's words and health behaviors. C. Refer client to others in the health team. D. Teach client about solutions to his or her problems. ------CORRECT ANSWER---------------A Agreement between the nurse and client that is focused on enhancing and supporting the client's active role in health care by defining who will do what to accomplish health-related goals ------CORRECT ANSWER----------- ----Contracting Individual in context of family influences. "Why do you smoke?" ------ CORRECT ANSWER---------------Family as the context Surveillance ------CORRECT ANSWER---------------Purple Disease investigation ------CORRECT ANSWER---------------Purple Outreach ------CORRECT ANSWER---------------Purple Screening ------CORRECT ANSWER---------------Purple Case finding ------CORRECT ANSWER---------------Purple Referral/follow-up ------CORRECT ANSWER---------------Green Case management ------CORRECT ANSWER---------------Green Delegated functions ------CORRECT ANSWER---------------Green Health teaching ------CORRECT ANSWER---------------Blue Counseling ------CORRECT ANSWER---------------Blue Consultation ------CORRECT ANSWER---------------Blue Collaboration ------CORRECT ANSWER---------------Red - Pulmonary congestion: orthopnea, cough, poor O2 - Decreased SV: Fatigue, Activity intolerance, Weakness What two conditions cause a diastolic murmur? ------CORRECT ANSWER- --------------mitral valve stenosis and aortic regurgitation What conditions cause a systolic murmur? ------CORRECT ANSWER-------- -------mitral valve regurgitation and aortic stenosis What is mitral valve prolapse (MVP) and regurgitation? What are some manifestations? ------CORRECT ANSWER---------------- Mitral valve does not close properly and blood leaks from the LV --> LA - Palpations, rhythm disturbances, dizziness, dyspnea, chest pain, anxiety What is aortic valve stenosis? What are some manifestations? ------ CORRECT ANSWER---------------- Impedes blood flow from the LV --> aorta, which leads to LV hypertrophy --> LV failure = VERY BAD - Angina, syncope, fatigue, hypotension, decreased peripheral pulses What is aortic regurgitation? What are some manifestations? ------ CORRECT ANSWER---------------- aortic valve does not close properly, which causes blood to flow back into the LV = LV hypertrophies and dilates - dyspnea with exertion, orthopnea, bounding peripheral pulses, increased SBP and decreased DBP What're the two forms of Parkinson's disease? ------CORRECT ANSWER--- ------------- Idiopathic Parkinson's Disease - Secondary parkinsonism - caused by trauma, infection, tumor, atherosclerosis, toxins Describe the pathophysiology of Parkinson's disease. What is the primary imbalance involved? ------CORRECT ANSWER---------------- Dopamine secreting neurons deep in the basal ganglia (extrapyramidal brain nuclei) -- > influences initiation, modulation & completion of movement - Degeneration of dopamine neurons = deficiency in dopamine and normal Ach levels What are the four classic manifestations of Parkinson's disease? ------ CORRECT ANSWER---------------- Resting tremor: asymmetric, rhythmic, low amplitude - Bradykinesia: slowness of voluntary movement; failure of antagonistic muscles to relax - Rigidity: involuntary contraction of striated muscle - Postural dysfunction: balance problems; shuffling gait What is a seizure disorder? What is the difference between primary and secondary seizures? ------CORRECT ANSWER---------------• Condition of the brain characterized by susceptibility to recurrent seizures; paroxysmal events associated with abnormal electrical discharges of neurons in the brain • Primary: Idiopathic = without apparent structural changes • Secondary: structural changes or metabolic alterations = increased automaticity What is the pathophysiology of a seizure disorder? ------CORRECT ANSWER---------------• Resting membrane potential is less negative = inhibitory connections are missing • Epileptogenic focus fires = electical current spreads to surrounding cells (fires with greater amplitude) • Impulses cascade to one side of brain (partial) or both sides (generalized) • Increased demand for O2 --> can lead to brain damage • Firing of inhibitory neurons causes the excited neurons to slow and stop What is an epileptogenic focus? ------CORRECT ANSWER--------------- Neurons in the brain depolarize or become hyperexcitable = fires more readily than normal when stimulated What are the two types of partial seizures and what are their differences? -- ----CORRECT ANSWER---------------• simple partial (Jacksonian): locally and does not cause an alteration in consciousness • complex partial: alters consciousness; amnesia before and afterwards; lasts longer (1-3 minutes) What are the different types of generalized seizures? Which one is the most dangerous? ------CORRECT ANSWER---------------• Abscence (petit mal): brief change in LOC and 1-10 sec • Myoclonic: involuntary muscular jerks; LOC not affected • Tonic-clonic (grand mal): loud cry --> LOC --> body spasms and relaxes; lasts 2-5 min = BAD What are the four types of primary/direction brain injuries? ------CORRECT ANSWER---------------Concussion, post-concussion syndrome, contusion, laceration What are the four types of secondary brain injuries? ------CORRECT ANSWER---------------Ischemia, increased ICP, cerebral edema, brain herniation Explain the mechanism of a brain injury. ------CORRECT ANSWER----------- ----• traumatic injury • swelling/bleeding = increase in ICV • increase in ICP • squished vessels = less flow • hypoxia and ischemia • more increase in ICP • no more blood flow What is a lucid interval? For which hematoma does that occur in? ------ CORRECT ANSWER---------------• A lucid interval is described as a brief period of unconsciousness followed by alertness; after several hours, the client again loses consciousness • Epidural hematoma Where does an intracerebral hematoma most likely occur? ------CORRECT ANSWER---------------Any lobe, but most commonly in the frontal and temporal What is one way that nurses can lower intracranial blood volume (Monroe- Kellie)? ------CORRECT ANSWER---------------• hyperventilation to lower PCO2 = vasoconstriction What is a normal cerebral perfusion pressure? What is the equation for this value? What value indicates brain ischemia? ------CORRECT ANSWER----- ----------• normal CPP = 70-100 mmHg • CPP = MABP - ICP • brain ischemia: <50-70 mmHg What is stage 1 of intracranial HTN? ------CORRECT ANSWER---------------• Compensation • increased volume in one compartment = decreased in one of both other compartment volumes What is stage 2 of intracranial HTN? ------CORRECT ANSWER---------------• increased ICP • brain constricts cerbral arteries to reduce pressure; however, hypoxia and hypercabia result in brain deterioration What is stage 3 of intracranial HTN? ------CORRECT ANSWER---------------• Decompensation • cerebral arteries respond with reflex dilation = increased BV and ICP • pressure/volume theory What is stage 4 of intracranial HTN? ------CORRECT ANSWER---------------• herniation or loss of CPP • swelling = more pressure = herniation • ICP = MABP = no cerebral perfusion Important: what is the earliest and most reliable sign of an increase in ICP? ------CORRECT ANSWER---------------• a decrease in level of consciousness (LOC) What is Cushing Reflex? How does it occur and what triggers it? ------ CORRECT ANSWER---------------• CNS ischemic response triggered by ischemia of vasomotor center in brain - increased mean arterial blood pressure - widening pulse pressure - reflex slowing of the heart rate What is a brain herniation? ------CORRECT ANSWER--------------- Displacement of brain tissue under the falx cerebri or through the tentorial notch or incisura of the tentorium cerebelli Where is an epidural hematoma most likely to occur? How does this type of hematoma form? ------CORRECT ANSWER---------------• Middle meningeal membrane under the temporal bone What is a CT scan good for, and what can it miss at times? ------CORRECT ANSWER---------------- can image large disc herniations - sometimes misses smaller ones What is an electromyography useful for? ------CORRECT ANSWER---------- -----Useful to distinguish nerve degeneration (neuropathy) from nerve root compression (radiculopathy) When are UMN lesions affected? What do they result in? ------CORRECT ANSWER---------------• Affected by any injury at the T12 level or above • Results in spastic paralysis of affected skeletal muscle groups, and muscles that control bowel, bladder, and sexual function When are LMN lesions affected? What do they result in? ------CORRECT ANSWER---------------• Occur with injuries below T12 • Result from damage to the peripheral nerves that exit each segment of the spinal cord • Causes flaccid paralysis of involved skeletal muscle groups and muscles that control bowel, bladder, and sexual function C1 to C3 injury: ------CORRECT ANSWER---------------Lack of respiratory effect; requires ventilator C3 to C5 injury: ------CORRECT ANSWER---------------Partial or full diaphragm function but ventilation is diminished Below C5: ------CORRECT ANSWER---------------Ability to take a deep breath and cough less impaired What muscles are innervated by T1 to T7? ------CORRECT ANSWER-------- -------Intercostal muscles What types of muscles are innervated by T6 to T12? ------CORRECT ANSWER---------------Muscles used for expiration What is the most severe ANS dysfunction? ------CORRECT ANSWER------- --------Circulatory function and thermoregulation What does the vagus nerve do? What does vagal stimulation lead to? ------ CORRECT ANSWER---------------• Inhibitory effect on HR • Bradycardia or asystole What are two ways to elicit vagal stimulation? ------CORRECT ANSWER---- -----------• Deep tracheal suctioning = hyperoxygenate • Rapid position change What is automonic dysreflexia? What is it caused by? What are three characteristics? ------CORRECT ANSWER---------------• Acute episode of exaggerated sympathetic reflex responses • Caused by visceral stimuli that normally cause pain or discomfort in the abdominopelvic region • HTN, bradycardia, headache Who is affected by postural hypotension? What is it? What are some signs? ------CORRECT ANSWER---------------• T4 to T6 and above • related to interruption of descending control of sympathetic outflow to vessels in the extremities and abdomen --> pooling of blood = low CO (cannot vasoconstrict) • dizziness, pallor, excessive sweating, blurred vision, fainting What is a common circulatory system dysfunction for SCI? ------CORRECT ANSWER---------------• edema and DVT • increased venous pressure and pooling of blood in lower body Most common disk herniation: ------CORRECT ANSWER--------------- Posterior & oblique toward the intervertebral foramen and contained spinal nerve root, and dorsal root ganglion Most common lumbar and cervical herniations? ------CORRECT ANSWER- --------------• Lumbar: L4 to L5 or L5 to S1 • Cervical: C6 to C7 and C5 to C6 What is the relationship between Na+, Cl-, K+, Ca2+, and phosphorus? ---- --CORRECT ANSWER---------------• Na+ = Cl- = Ca2+ Osteodystrophy alterations during renal failure: ------CORRECT ANSWER-- -------------• High bone turnover (osteitis fibrosa) or low bone turnover (osteomalacia) Manifestations • muscle weakness • bone pain and tenderness • spontaneous fractures What kind of skin is observed for patients with CKD? Why does this happen? ------CORRECT ANSWER---------------• Dry, itchy, pale skin caused by deposits of phosphates, uric acid, and urea; also due to low oil gland activity What is calciphylaxis? ------CORRECT ANSWER---------------Fatal syndrome of vascular calcification, thrombosis, and skin necrosis What are three processes that a hemodialysis target? ------CORRECT ANSWER---------------• Separates elements in a solution by diffusion • Removes end products of nitrogen metabolism (urea, creatinine, uric acid) • Replenishes bicarbonate deficit (metabolic acidosis) What particles are too large to cross over the semi-permeable membrane during hemodialysis? ------CORRECT ANSWER---------------Blood, cells, plasma proteins, bacteria What is the urinary output for the oliguric phase of AKI? What are some complications? ------CORRECT ANSWER---------------50-400 mL Infection, heart value d/t hypovolemia, pulmonary edema, hyperkalemia, metabolic acidosis, GI bleeding, anemia What happens during the diuretic and recovery phase? ------CORRECT ANSWER---------------The kidneys recover their ability to excrete waste but cannot concentrate the urine. Hypovolemia and hypotension may occur due to massive volume loss. What are a few pre-renal causes of AKI? ------CORRECT ANSWER---------- -----Hypovolemia, cardiovascular disorders, peripheral vasodilation, renovascular obstruction, vasocontriction What are a few post-renal causes of AKI? ------CORRECT ANSWER--------- ------Ureteral obstruction, bladder obstruction, urethral obstruction (benign prostatic hypertrophy) What are a few instra-renal (renal) causes of AKI? ------CORRECT ANSWER---------------Acute tubular necrosis, obstetric complications, pigment release NURS 361 PRACTICE EXAM Mental Health ------CORRECT ANSWER----------------Difficult to define -No single, universal definition -Many components influence by factors -Dynamic, ever-changing state -Influencing factors: Individual (personal), Interpersonal (relationship), Social/Cultural (environmental) Mental illness ------CORRECT ANSWER----------------Includes disorders that affect: Mood, Behavior, Thinking -These often indicate signs of distress and/or impaired functioning DSM V ------CORRECT ANSWER---------------Taxonomy published by the American Psychiatric Association DSM V (purposes) ------CORRECT ANSWER----------------Standardize nomenclature, language -Identify defining characteristics or symptoms -Assist in identifying underlying causes DSM V (classification) ------CORRECT ANSWER---------------Allows the practitioner to identify all factors that relate to a patient's conditions: -Major psychiatric disorders -Medical conditions -Psychosocial & Environmental problems Ancient Times (historical perspective) ------CORRECT ANSWER-------------- --Sickness as displeasure of gods; punishment for sins; viewed as demonic or divine -Aristotle & imbalances of the four humors (blood, water, yellow & black bile); balance restoration via bloodletting, starving, purging -Early Christians' view as possession by demon Period of Enlightenment (historical perspective) ------CORRECT ANSWER- ---------------1790s Phenomena of concern (13) ------CORRECT ANSWER---------------- Promotion of optimal mental & physical health & well-being & prevention of mental illness -Impaired ability to function related to psychiatric, emotional, physiologic distress -Alterations in thinking, perceiving, & communicating bc of psychiatric disorders or mental health problems -Behaviors & mental states that indicate potential danger to self or others -Emotional stress related to illness, pain, disability, loss -Symptom management, side effects, or toxicities associated with self- administered drugs, psychopharmacologic intervention, other drug tx modalities -The barriers to tx efficacy & recovery posed by alcohol & substance abuse & dependence -Self-concept & body image changes, developmental issues, life process changes, end-of-life issues -Physical symptoms that occur along with altered physiologic status -Interpersonal, organizational, sociocultural, spiritual, or environmental circumstances or events that help individuals reengage in seeking meaningful lives -Societal factors such as violence, poverty, substance abuse APNA areas of practice (Basic-Level Functions) ------CORRECT ANSWER- ---------------Counseling -Milieu therapy -Self-care activities -Psychobiologic interventions -Health teaching -Case management -Health promotion & maintenance APNA areas of practice (Advanced-Level Functions) ------CORRECT ANSWER----------------Psychotherapy -Prescriptive authority for drugs (in many states) -Evaluation -Program development & management -Clinical supervision Locus Coeruleus (brain) ------CORRECT ANSWER----------------Small area of brain that produces norepinephrine -Associated with: Stress, Anxiety, Impulsive behavior Frontal lobe (brain) ------CORRECT ANSWER---------------Abnormalities associated with: -Schizophrenia -ADHD -Dementia Limbic System (brain) ------CORRECT ANSWER---------------(thalamus, hypothalamus, hippocampus, amygdala) Disturbances associated with: -Memory loss that accompanies dementia -Poorly controlled emotions & impulses with psychotic or manic behaviors Dopamine ------CORRECT ANSWER---------------(excitatory) -Controls complex movements, motivation, cognition -Regulates emotional response Hypothalamus (brain) ------CORRECT ANSWER---------------Associated with impulsive behavior associated with feelings of anger, rage, or excitement Norepinephrine (noradrenaline) ------CORRECT ANSWER--------------- (excitatory) -Causes changes in attention, learning & memory, sleep & wakefulness, mood Epinephrine (adrenaline) ------CORRECT ANSWER---------------(excitatory) -Controls fight or flight response Serotonin ------CORRECT ANSWER---------------(inhibitory) -Controls food intake, sleep & wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions Histamine ------CORRECT ANSWER---------------(neuromodulator) -Controls alertness, gastric secretions, cardiac stimulation, peripheral allergic responses Acetylcholine ------CORRECT ANSWER---------------(excitatory or inhibitory) -Controls sleep & wakefulness cycle -Signals muscles to become alert -associated with Alzheimer's disease & myasthenia gravis Neuropeptides ------CORRECT ANSWER---------------(neuromodulators) -Enhance, prolong, inhibit, or limit the effects of principal neurotransmitters Glutamate ------CORRECT ANSWER---------------(excitatory) -Results in neurotoxicity if levels are too high Efficacy ------CORRECT ANSWER---------------Maximal therapeutic effect that a drug can achieve Potency ------CORRECT ANSWER---------------The amount of drug needed to achieve that maximum effect Half-Life ------CORRECT ANSWER---------------The time it takes for half the drug to be removed from the bloodstream Off-Label Use ------CORRECT ANSWER---------------A drug will prove effective for a disease that differs from the one involved in original testing and FDA approval Black Box Warning ------CORRECT ANSWER---------------Medication package inserts must have a highlighted box, separate from the text, that contains a warning about the life-threatening or otherwise serious side effect(s) of the medication Principles that Guide Pharmacologic Treatment ------CORRECT ANSWER- ---------------Effect on target symptoms -Adequate dosage for sufficient time -Lowest effective dose -Lower doses for older adults (can't break them down as well) -Tapering rather than abrupt cessation to avoid rebound, recurrence of symptoms, or withdrawal -Follow-up care -Simple regimen to increase compliance Antipsychotic Drugs ------CORRECT ANSWER---------------Used to treat symptoms of psychosis, such as the delusions & hallucinations seen in schizophrenia, schizoaffective disorder, & the manic phase of bipolar disorder Conventional (first generation) Antipsychotics ------CORRECT ANSWER---- ------------Block D2, D3, and D4 -Have higher rates of extrapyramidal side effects Atypical (second generation) Antipsychotics ------CORRECT ANSWER------ ----------Block D3, D4 (does not block D2) -Lower incidence of extrapyramidal effects -Inhibit the reuptake of serotonin (like antidepressants and so work better on the depressive symptoms, but can increase mortality rates for elderly patients) Third generation (antipsychotics) ------CORRECT ANSWER---------------- Dopamine system stabilizers -Work well without some of the side effects noted with the 1st & 2nd -They can cause weight gain, akathisia, headache, anxiety, & nausea Depot Injection ------CORRECT ANSWER----------------Long acting antipsychotics -Time-release form of intramuscular medication form maintenance therapy Extrapyramidal Symptoms (EPS) ------CORRECT ANSWER---------------- Serious neurologic symptoms that are the major side effects of antipsychotic drugs -Includes dystonia, pseudoparkinsonism, and akathisia -Blockade of D2 is responsible Dystonia ------CORRECT ANSWER----------------Acute muscular rigidity & cramping -A stiff or thick tongue with difficulty swallowing -In severe cases: laryngospasms & respiratory difficulties -TX: anticholinergic drugs or diphenhydramine Akathisia ------CORRECT ANSWER----------------Restlessness -Anxiety -Agitation Neuroleptic Malignant Syndrome (NMS) ------CORRECT ANSWER----------- -----A potentially fatal, idiosyncratic reaction to an anti-psychotic (or neuroleptic) drug -High fever, unstable BP, diaphoresis & pallor, delirium, & elevated enzymes Tardive Dyskinesia ------CORRECT ANSWER----------------A syndrome of permanent involuntary movements -Is most commonly caused by the long term use of conventional antipsychotic drugs Anticholinergic Effects ------CORRECT ANSWER----------------Orthostatic hypotension -Dry mouth -Constipation -Urinary hesitance or retention -Blurred near vision -Red wine, beer, sherry -Sausage, bologna, pepperoni, salami -Sour cream -Soy sauce -Yogurt SSNI (Side Effects) ------CORRECT ANSWER----------------Anxiety -Agitation -Akathisia -Nausea -Insomnia -Sexual dysfunction -Weight gain MAOI (Side Effects) ------CORRECT ANSWER----------------Daytime sedation -Weight gain -Dry mouth -Orthostatic hypotension -Sexual dysfunction -Hypertensive crisis (w/ foods containing Tyramine) TCA (Side Effects) ------CORRECT ANSWER----------------Anticholinergic effects -Orthostatic hypotension -Sedation -Weight gain -Tachycardia Other Antidepressants (Side Effects) ------CORRECT ANSWER--------------- -Sedation, headaches (Nefazodone, Trazodone) -Loss of appetite, nausea, agitation, insomnia (Bupropion, Venlafaxine) -Priapism (Trazodone) -Nefazodone can cause life threatening liver damage -Bupropion can cause seizures at the rate of 4X that of other Serotonin Syndrome ------CORRECT ANSWER----------------MAOI + SSRI -Agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia -Coma, death (extreme reactions) Lithium (safe range) ------CORRECT ANSWER---------------0.6-1.2 or 0.5- 1.5 ?? Lithium (side effects) ------CORRECT ANSWER----------------Nausea -Diarrhea -Anorexia -Fine hand tremor -Polydipsia -Metallic taste in the mouth -Fatigue -Lethargy Lithium (signs of toxicity) ------CORRECT ANSWER---------------Severe diarrhea, vomiting, drowsiness, muscle weakness, & lack of coordination Anticonvulsants ------CORRECT ANSWER----------------Carbamazepine -Valproic Acid -Gabapentin -Topiramate -Oxcarbazepine -Lamotrigine Anticonvulsants (side effects) ------CORRECT ANSWER---------------- Carbamazepine: rash, orthostatic hypotension -Valproic Acid: weight gain, alopecia, hand tremor -Topiramate: dizziness, sedation, weight loss -Lamotrigine: serious rash requiring hospitalization more common in those younger than 16 Lamotrigine (warning) ------CORRECT ANSWER---------------Serious rash requiring hospitalization more common in those younger than 16 Benzodiazepines (anxiolytics) ------CORRECT ANSWER---------------- Alprazolam -Chlordiazepoxide -Clonazepam -Clorazepate -Diazepam -Flurazepam -Lorazepam -Oxazepam -Temazepam -Triazolam Nonbenzodiazepines (anxiolytics) ------CORRECT ANSWER--------------- Buspirone (BuSpar) Stimulants ------CORRECT ANSWER----------------Treatment of ADHD in children, adolescents -Residual attention-deficit disorder in adults -Narcolepsy Transference (Psychoanalytic Theory) ------CORRECT ANSWER------------- --Client displaces onto the therapist attitudes & feelings that the client originally experienced in other relationship Countertransference (Psychoanalytic Theory) ------CORRECT ANSWER---- -----------Therapist displaces onto the client attitudes or feelings from his or her past Developmental Theories ------CORRECT ANSWER----------------Erikson -Piaget Erikson (Psychosocial Stages of Development) ------CORRECT ANSWER-- --------------Trust vs mistrust (infant) -Autonomy vs shame & doubt (toddler) -Initiative vs guilt (preschool) -Industry vs inferiority (school age) -Identity vs role confusion (adolescence) -Intimacy vs isolation (young adult) -Generativity vs stagnation (middle adult) -Ego integrity vs despair (older adult) Piaget (Cognitive Stages of Development) ------CORRECT ANSWER-------- --------Sensorimotor (birth-2) -Preoperational (2-6) -Concrete operational (6-12) -Formal operational (12-15) Interpersonal Theories ------CORRECT ANSWER----------------Sullivan -Peplau Sullivan (Interpersonal Relationships & Milieu Therapy) (life stages) ------ CORRECT ANSWER----------------Infancy -Childhood -Juvenile -Preadolescence -Adolescence Sullivan (Interpersonal Relationships & Milieu Therapy) (cognitive modes) - -----CORRECT ANSWER----------------Prototaxic (infancy, childhood) -Parataxic (early childhood) -Syntaxic (school-aged children; more predominant in preadolescence) Peplau (Therapeutic Nurse-Patient Relationships) (phases) ------CORRECT ANSWER----------------Orientation -Identification -Exploitation -Resolution Peplau (Therapeutic Nurse-Patient Relationships) (roles) ------CORRECT ANSWER----------------Stranger -Resource person -Teacher -Leader -Surrogate -Counselor Peplau (Therapeutic Nurse-Patient Relationships) (anxiety levels) ------ CORRECT ANSWER----------------Mild -Moderate -Severe -Panic Humanistic Theories ------CORRECT ANSWER----------------Maslow -Rogers Maslow (Hierarchy of Needs) ------CORRECT ANSWER----------------Basic physiologic -Safety & security -Love & belonging -Esteem -Self-actualization Rogers (Client-Centered Therapy) ------CORRECT ANSWER--------------- Focuses on the client, rather than the therapist, as the key to the healing process Unconditional Positive Regard (Rogers) ------CORRECT ANSWER----------- ----A nonjudgmental caring for the client that is not dependent on the client's behavior Genuineness (Rogers) ------CORRECT ANSWER---------------Realness or congruence between what the therapist feels & what he or she says to the client Empathetic Understanding (Rogers) ------CORRECT ANSWER--------------- Tee therapist senses the feelings & personal meaning from the client & communicates this understanding to the client