NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

Statistical Analysis Chapter 4 and 5

I need someone who is good at APA tables and statistical analysis. The information is already in the attachment. The tables and charts must be in APA format   

Chapter 4: Data Analysis and Results

This chapter will review the collected data, evaluate methods used to analyze the data, and appraise the findings of the study. The purpose of this quantitative project was to determine the degree of relationship between the independent variale of nurse’s participation in an evidence-based CLABSI prevention using CHG bathing and the dependent variables of lowering CLABSI rates in patients with CVCs in a healthcare facility in Texas. The quantitative research methodology was selected as a means to review the collected data, evaluate and analyze the data and to appraise the findings of the quality improvement project. The purpose of the project is to explore the problem of CLABSIs and examine available measures to prevent, control, reduce incidences, and to implement a quality improvement project set forth by this investigator to decrease CLABSIs. More importantly, the project seeks to contribute to the field of evidence-based practices in nursing by showing the role of the nurse in helping to reduce HAIs, such as CLABSIs, in the adult critical care setting. In particular, the present project proposes nurse training on the CUSP toolkit and additional CLABSI maintenance, including CHG bathing as an intervention to prevent CLABSI. Central line Venous Catheters (CVCs) are commonly used for inpatients hospitalized in acute care Intensive Care Units (ICU) to administer blood products, intravenous fluids, parenteral nutrition, and other types of medications, such as antibiotics. The use of catheters is, however, linked to the risk of developing a hospital-acquired infection (HAI), known as Central-line Associated Bloodstream Infection (CLABSI) mainly caused by microorganisms found on the external surface of the patient’s skin, improper hand hygiene, or in the fluid pathway post-catheter insertion. Notably, CVCs have been cited as the most frequent and costliest causes of bloodstream infections (Haddadin & Regunath., 2019). CLABSI prevention is one of seven requirements by the Joint Commission for hospitals to accredited nursing care centers and listed as a National Patient Safety Goal (NPSG) NPSG.07.04.01 (Yokoe et al., 2018).

Evidence-based practices, including CHG bathing, adequate hand hygiene, and clear de-escalation protocols for central lines that are no longer medically necessary, were utilized. The Comprehensive Unit-based Safety Program (CUSP) is a program designed to teach and enhance patient safety awareness as well as the quality of nursing care (Basinger, 2015). The project will implement CUSP, which is comprised of five basic steps. The CUSP process starts with providing education on the CUSP Central-line maintenance bundle that includes chlorohexidine gluconate (CHG) bathing, followed by the identification of weaknesses and risks in patient safety, then the partnering of a senior executive of the critical care unit, learning from the flaws, and the execution of communication and teamwork tools (Basinger, 2015). The core CUSP toolkit (appendix B) gives clinical teams the training resources and tools to apply the CUSP CHG bathing intervention for this project to prevent CLABSIs.

The present project will consist of audit tools on awareness and compliance, like the AHRQ CUSP CLABSI Central Line Maintenance Audit Form and CUSP toolkit (appendix B) in which proper maintenance of CLABSI is ensured (Baldassarre, Finkelston, Decker, Lewis, & Niesley, 2015). A CUSP CLABSI maintenance audit tool (Appendix B) was used on the nurses providing care on those patients with CVCs were used within the adult ICU at Texas hospital, to help in determining the CLASBI maintenance bundle compliance. The results of the project were analyzed using the necessary statistical methods to help in establishing the conclusion of the results. The Texas hospital’s nursing data portal was used to gather statistical data that will determine if CHG use has helped reach the benchmark goal of SIR = 75th percentile and the Goal Process Measures or KPIs = 90% compliance compared to other hospitals in the division. Currently, in the last quarter of 2019, the benchmark of the 75th percentile has been achieving post quality improvements that include the addition of CHG bathing. CUSP CLABSI maintenance audit tool (Appendix B) (Heale & Twycross, 2015). Statistical significance was calculated at a p-value of < .05 and a 95% confidence interval. The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) developed and used standardized infection ratios (SIRs) to measure healthcare-associated infection (HAI) incidence (Soe, Gould, Pollock, & Edwards, 2015). 

The Infection rate is calculated using the overall percentage of infection by dividing the number of new cases by the average census and multiplying by 100. For more specific rates, the number will be provided by dividing the number of new cases by the total resident days and multiply by 1000, which gives you the number of infections per 1000 resident days (Liu et al., 2016). Standardized Infection Ratio (SRI) is expressed as a ratio and is the comparison of the actual number of HAIs to the predicted number of HAIs in a healthcare organization. This value is based upon data reported to National Healthcare Safety Network (NHSN) during a specified time period. The Hospital Corporation of America’s (HCA) goal is 75th percentile. A SIR can only be calculated if there is at least one predicted infection

Goal: SIR = 75th percentile

To assist in determining if patient outcomes could be improved using simulation 

activities, a rural healthcare facility in Southeast Texas, was chosen to conduct the project. The methodology used for this project was quantitative. A quantitative methodology was chosen to provide absolute value to the rate of incidence or occurrence of adverse events to support measurement of the difference between pre- and post-simulation intervention. A quasi-experimental design was used as participants were not randomly selected. This approach suited the request of the institution to include nurses working in the ED. 

Using comparative analysis, the CUSP CLABSI Central Line Maintenance Audit Form (appendix B) shows > 90 percent compliance, the data met the key performance indicators (KPIs) for a decrease in CLABSI and it’s compliance with evidence based standars has brought down CLABSI infection rates. The Goal Process Measures or KPIs (key performance indicators) = 90% compliance. The bullet graph (Table 1) at the top right corner of Nursing Data Portal trending screens, outlines how to read and interpret progress on performance milestones. The purpose of this chapter is to summarize the collected data, how it was analyzed, and then to present the results. 

Table 1

Table 1 shows the Hospital KPI performance graph on CHG bathing from the organization’s Nursing Data Portal. The table shows the prior month and current month percentage labeled 0% to 100%. Moving from left to right, the graph shows the organization’s divisional average at 50% and next the HCA corporate average of 70%. Aspiration goals for CHG bathing are set for the 75th percentile with higher aspirational goals set at 100% or in the 90th percentile. 

Table 2[A1] 

In the present project, a CVC maintenance bundle checklist (Appendix D) was used to observe nurses in the adult ICUs of an acute Texas hospital. The observation will involve the Central Line Audit Form (Appendix B) comparing nurse’s compliance regarding CVC maintenance and any significant definite statistical decrease in the reported standardize infection rates and was done for one month (Table 3). In 2019 in the first two quarters, the facility has already reported 20 HAIs, according to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) (Painter, 2018). From May to September (five-month trend) the Texas hospital was at 96% overall performance, and the division in which it belongs, the Gulf Coast Division, was at 97% with the goal of overall performance being 98% of all HCA hospitals (Table 2). [A2] The next five-month trend from August to November, the Texas hospital was at 95% overall performance, and the division in which it belongs, the Gulf Coast Division, was at 89% with the goal of overall performance being 98% of all HCA hospitals (Table 2). CLABSI infection and prevention are a factor in the overall performance both at the local, division and national levels. Other size hospitals in Texas have an average of 15 CLABSI per year (Liu et al., 2016). The present project will apply the quantitative approach, which was used in data collection and analysis. The present project will consist of audit tools on awareness and compliance, like the AHRQ CUSP CLABSI Central Line Maintenance Audit Form and CUSP toolkit (appendix B) in which maintenance of CLABSI is ensured (Baldassarre, Finkelston, Decker, Lewis, & Niesley, 2015). A CUSP CLABSI Central Line Maintenance Audit Form (appendix B) on the nurses providing care on those patients with CVCs was used within the adult ICU at Texas hospital, to help in determining CLASBI maintenance CHG bathing compliance. The results of the project were analyzed using the necessary statistical methods to help in establishing the conclusion of the results. CUSP CLABSI maintenance audit tool (Appendix B) (Heale & Twycross, 2015). Statistical significance was calculated at a p-value of < .05 at 5.59 or 5% and a 95% confidence interval. The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety [A3] Network (NHSN) developed and used standardized infection ratios (SIRs) to measure healthcare-associated infection (HAI) incidence (Soe, Gould, Pollock, & Edwards, 2015). The Infection rate calculation calculated using the overall percentage of infection by dividing the number of new cases by the average census and multiplying by 100. For more specific rates, divide the number of new cases by total resident days and multiply by [A4] 1000, which gives you the number of infections per 1000 resident days (Liu et al., 2016). Using comparative analysis, if the CUSP CLABSI Central Line Maintenance Audit Form (appendix B) shows 90 percent compliance, the data met the KPIs for a decrease in CLABSI. In the present project, a CVC maintenance bundle checklist (Appendix E) was used to observe nurses in the adult ICUs of an acute Texas hospital. The observation involved the Central Line Audit Form (Appendix B) comparing nurses’ compliance regarding [A5] CVC maintenance and any significant definite statistical decrease in the reported standardize infection rates and was done for one month.

The following clinical question will guide this quantitative project: 

Q: In adult patients with central line catheters, how does staff training on the CUSP CLABSIs maintenance CHG bathing to reduce the incidence of CLABSIs (Central Line-Associated Blood-stream Infections) compared to standard care over one month?

Standard care here is defined as procedural pause, aseptic techniques, hand hygiene, and optimal site selection, to protect the insertion site and to take maximal sterile precautions (Advani, Lee, Long, Schmitz, & Camins, 2018).

    

Criterion

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Comments or Feedback

 

INTRODUCTION (TOTHE CHAPTER)

This section of Chapter 4 briefly restates   the problem statement, the methodology, the clinical question(s) or   phenomena, and offers a statement about what will be covered in this chapter.   

1

 

Re-introduces the purpose of the practice   project.

1

 

Briefly describes the project methodology   and/or clinical question(s) tested.

1

Develop project methodology.

 

Provides an orienting statement about what   will be covered in the chapter.

2

 

Section is written in a way that is well   structured, has a logical flow, uses correct paragraph structure, uses   correct sentence structure, uses correct punctuation, and uses correct APA   format. 

2

 

NOTE:   Once the document has been approved by your chairperson and your committee   and is ready to submit for review, please remove all of these assessment   tables from this document.

Score 0   (not present); 1(unacceptable; needs substantial edits); 2 (present, but   needs some editing); 3 (publication ready).

Descriptive Data

A CHG bath/treatment must be given each day (based off midnight census) for a patient in the adult ICU with a central line, hemodialysis catheter, PICC, midline, or accessed port, and the CHG bath must be documented as per the Texas hospital’s policy. The Texas hospital utilizes Meditech 5.6.x Source System to documents daily CHG bathing (Appendix F). CHG bathing is tracked through the hospital’s Nursing Data Portal, a division-wide analytics program. CHG bathing is tracked through the Texas hospital’s Nursing Data Portal, a division-wide analytics program. This portal can track CHG compliance, date and time of bath, CVC placement, type of lumens, date and time of access, and any reason CHG bathing was not performed (Appendix E) on the CVC patient, both intervention and nonintervention groups were determined via the CUSP CLABSI Maintenance Audit form. 

The CUSP CLABSI Maintenon Audit form asks the following questions: Was the need for a central line for this patient discussed on patient rounds? Was good hand hygiene used by all personnel involved in line care for this patient (i.e., handwashing with soap and water or with alcohol-based hand sanitizes. If the line was percutaneously placed, was this line placed in a recommended site? Was the dressing changed during this shift? Was Chloraprep or 2% chlorhexidine in 70% Isopropyl alcohol used for skin antisepsis? Were central line tubing and all additions (secondary tubing, etc.) changed during this shift? Was there blood return from each lumen? Was chlorhexidine impregnated BioPatch used? Was a chlorhexidine impregnated occlusive dressing used? Was an antibiotic coated catheter used at insertion? What will you change to improve line maintenance practices? (Appendix B and E). 

A CHG bath/treatment must be given each day for a patient in the ICU with a central line, hemodialysis catheter, PICC, midline, or accessed port, and the CHG bath must be documented in Meditech 5.6x. per the Texas hospital’s policy. From the nursing data portal, this project  the project investigator was able to gather statistical data that determined that CHG use has helped reach the goal of SIR = 75th percentile and the Goal Process Measures or KPIs of 90% compliance. Tallied scores (Table 4) were entered into SPSS Statistics program to give a percentage of CUSP CVC intervention and non-intervention groups with the number of new CLABSI patients in each group. This KPI was determined by a decrease in CLABSI rates. Occurrences of events constitute discrete data and are recorded in whole numbers and into various categories (Ali & Bhaskar, 2016). Entered in the SPSS program was the independent variable, which is all the nurses in the present project. This group was further divided into two variables an intervention group and a non-intervention group. The intervention group being nurses implementing CUSP CLABSI maintenance bundle CHG bathing and non-interventional group nurses who are attending patients without CHG bathing. All 60 comprised of 30 nurses in each group were coded in Camel case and number, for example, Nurs1 to maintain confidentiality. Dependent variables or numberof infections entered into the SPPS program the quantitative CUSP CLABSI maintenance CHG bathing intervention performed in the adult ICU at Texas hospital. Data entered will allow the investigator to create statistical graphs such as histogram, bar charts, Tukey box plots, line graphs, and scatterplots to give a visual representation of the collected data. The investigator expects that the CUSP intervention groups will have a level of statistical significance of lower CLABSI. CUSP Central line maintenance bundle compliance was measured with the CUSP CLABSI Central line Maintenance Audit Form (appendix B) with the reported standard infection ratio (SIR). The present project shows that the SIR will decrease with the addition of the CHG bathing, and using inferential statistics.

Calculation of the p-value and paired t-test was completed to compare the means of the sample groups (intervention and nonintervention) (Table 3). Statistical significance was calculated at a p-value of < .05 and a 95% confidence interval. Tallied compliance scores from the CUSP CVC audit form were entered SPSS Statistics program to give a percentage of CUSP CVC intervention and non-intervention groups with the number of new CLABSI patients in each group.

The information filled in the audit (Appendix B) were collected and coded to help in carrying out an unbiased de-identified analysis (See Table 4). The coded data were analyzed using the SPSS software to assist in getting the quantitative aspects of the data (Mihas, 2019). Calculation of standard deviation, p-value, and paired t-test was completed to compare the means of the sample groups. Statistical significance was calculated at a p-value of < .05 and a 95% confidence interval. Statistical tests are used to see if the difference between the number of actual infections, and the number of predicted infections are due to just chance alone. If it is doubtful that the difference is due to chance, then the difference is called “statistically significant.” If the SIR is less than 1, and the finding is statistically significant, then the facility’s performance is labeled “Better than Expected.” If the SIR is greater than 1, and the finding is statistically significant, then the facility’s performance is labeled “Worse than Expected.” If the SIR is not statistically significant, then the facility’s SIR is “In the expected range” (Saman & Kavanagh, 2013). When the predicted number of infections is less than 1, then the numbers are too small to compare.” Equally, the investigator used descriptive aspects of the data to assist in making meaning out of any complex scientific elements of the data. The analysis of the data is critical clinically in achieving the objective of the project and answering the clinical questions regarding CLABSI prevention and CHG maintenance (Saman & Kavanagh, 2013). 

Table 3

   

CHG Audit Dates

30-days pre- intervention

CHG Intervention 

No CHG Intervention

No of Infection

with CHG Intervention

No of Infection

without CHG Intervention

SIR 

Standard Infection Ratio

 

10/15-10/21

0

0

1

1

1

 

10/22-10/28

0

0

1

0

1

 

10/29-11/4

0

0

0

1

0

 

11/5-11/14

0

0

0

1

0

 

Mean

0

0

0.5

0.75

0.5

 

Standard Deviation

0

0

0

0.4

0

 

 

CHG Audit Dates

30-days poet-intervention

CHG Intervention 

No CHG Intervention

No of Infection

with Intervention

No of Infection

without Intervention

SIR

Standard Infection Ratio

 

11/15 -11/21

42

18

0

1

1

 

11/22 – 11/28

47

13

0

1

1

 

11/29-12/06

51

9

0

0

< 1

 

12/07 – 12/15

58

2

0

0

< 1

 

Mean

51.6

10.5

0

0.5

 

Standard Deviation

6.7

5.9

0

0.5

                

CVC/ PICC Line Days –     Current Census for Clear Lake (Campus: Clear Lake)

Date_______________

 

      

Nurse

De-identified

(Nurs1-Nurs60)

Location

ICU/NTICU/CCU

/CVICU

Patient

De-identified

(P1-P30)

Admit Date

Insertion Site

Location

Right/Left

Type

of Catheter

Start Date

CUSP

Audit

CHG Bath

(Y/N[A6] )

 

Nurs1

G.ICU

P1

ARM

RIGHT

CVC multi lumen double

Y

 

Nurs2

G.ICU

P2

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs3

G.ICU

P3

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs4

G.ICU

P4

ARM

RIGHT

Dialysis catheter triple

N

 

Nurs5

G.ICU

P5

ARM

LEFT

CVC multi lumen triple

N

 

Nurs6

G.ICU

P6

ARM

LEFT

CVC multi lumen triple

Y

 

Nurs7

G.ICU

P7

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs8

G.ICU

P8

ARM

LEFT

CVC multi lumen triple

N

 

Nurs9

G.ICU

P9

ARM

LEFT

Dialysis catheter triple

N

 

Nurs10

G.ICU

P10

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs11

G.ICU

P11

ARM

LEFT

Dialysis catheter triple

N

 

Nurs12

G.ICU

P12

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs13

G.ICU

P13

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs14

G.ICU

P14

ARM

RIGHT

CVC multi lumen double

Y

 

Nurs15

G.ICU

P15

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs16

G.ICU

P16

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs17

G.ICU

P17

ARM

RIGHT

Midline

Y

 

Nurs18

G.ICU

P18

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs19

G.ICU

P19

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs20

G.ICU

P20

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs21

G.ICU

P21

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs22

G.ICU

P22

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs23

G.ICU

P23

ARM

LEFT

CVC multi lumen double

Y

 

Nurs24

G.ICU

P24

ARM

RIGHT

Dialysis catheter triple

N

 

Nurs25

G.ICU

P25

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs26

G.ICU

P26

ARM

RIGHT

Midline

Y

 

Nurs27

G.ICU

P27

ARM

RIGHT

CVC multi lumen triple

N

 

Nurs28

G.ICU

P28

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs29

G.ICU

P29

ARM

LEFT

Dialysis catheter triple

N

 

Nurs30

G.ICU

P30

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs31

G.ICU

P31

ARM

LEFT

Dialysis catheter triple

N

 

Nurs32

G.ICU

P32

ARM

LEFT

CVC multi lumen triple

N

 

Nurs33

G.ICU

P33

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs34

G.ICU

P34

ARM

LEFT

CVC multi lumen double

Y

 

Nurs35

G.ICU

P35

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs36

G.ICU

P36

ARM

LEFT

CVC multi lumen triple

Y

 

Nurs37

G.ICU

P37

ARM

RIGHT

Midline

N

 

Nurs38

G.ICU

P38

ARM

CVC multi-lumen triple

N

 

Nurs39

G.ICU

P39

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs40

G.ICU

P40

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs41

G.ICU

P41

ARM

RIGHT

CVC multi lumen triple

N

 

Nurs42

G.ICU

P42

ARM

RIGHT

Dialysis catheter triple

N

 

Nurs43

G.ICU

P42

ARM

LEFT

CVC multi lumen double

N

 

Nurs44

G.ICU

P43

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs45

G.ICU

P44

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs46

G.ICU

P45

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs47

G.ICU

P46

ARM

LEFT

Dialysis catheter triple

N

 

Nurs48

G.ICU

P47

ARM

LEFT

CVC multi lumen triple

N

 

Nurs49

G.ICU

P48

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs50

G.ICU

P50

ARM

RIGHT

CVC multi lumen double

N

 

Nurs51

G.ICU

P51

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs52

G.ICU

P52

ARM

RIGHT

CVC multi lumen triple

N

 

Nurs53

G.ICU

P53

ARM

LEFT

Midline

Y

 

Nurs54

G.ICU

P54

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs55

G.ICU

P55

ARM

RIGHT

Dialysis catheter triple

N

 

Nurs56

G.ICU

P56

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs57

G.ICU

P57

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs58

G.ICU

P58

ARM

RIGHT

Dialysis catheter triple

N

 

Nurs59

G.ICU

P59

ARM

RIGHT

CVC multi lumen double

Y

 

Nurs60

G.ICU

P60

ARM

LEFT

Dialysis catheter triple

N

Table 4

    

Criterion

Learner Score
   (0, 1, 2, or 3)

Chairperson Score
   (0, 1, 2, or 3)

Comments or Feedback

 

DESCRIPTIVE DATA

This section of Chapter 4 provides a narrative summary of the population or sample   characteristics and demographics of the   participants in the project. It establishes the number of subjects, gender,   age, level (if appropriate), organization, or setting (if appropriate). The   use of graphic organizers, such as tables, charts and graphs to provide   further clarification and promote readability, is encouraged. 

1

 

Provides a narrative summary of the   population or sample characteristics and demographics.

1

 

Graphic organizers are used as appropriate   to organize and present coded data, as well as descriptive data such as   tables, histograms, graphs, and/or charts.

1

 

Section is written in a way that is well   structured, has a logical flow, uses correct paragraph structure, uses   correct sentence structure, uses correct punctuation, and uses correct APA   format. 

1

 

NOTE: Once the document has been approved by your chairperson and   your committee and is ready to submit for review, please remove all of these assessment   tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2   (present, but needs some editing); 3 (publication ready).

Data Analysis Procedures

A quantitative approach has been successfully used by McKim (2016) to identify barriers to compliance with evidence-based guidelines for central line management. The main objective of using this approach is to strengthen and/or expand conclusions, thereby contributing to existing knowledge. The approach helps to heighten knowledge and increase the validity of the results (Guetterman, Fetters & Creswell, 2015).

Reliability was addressed by ensuring that the instrument is consistent. The CUSP CLABSI Maintenance Central line audit was collected and coded to help in carrying out an unbiased analysis. The coded data were analyzed using the SPSS software to assist in obtaining the quality improvement aspects of the data (Mihas, 2019). Data were entered into the SPSS program were the independent variable, which is all the nurses in the present project. This group was further divided into two variables an intervention group and a non-intervention group. The intervention group being nurses implementing CUSP CLABSI maintenance bundle CHG bathing and non-interventional group nurses who are attending patients without CHG bathing. All 60 nurses 30 in each group were coded in Camel case and number, for example, Nurs1 to maintain confidentiality. Dependent variables or numberof infections entered into the SPPS program the quantitative CUSP CLABSI maintenance CHG bathing intervention performed in the adult ICU at Texas hospital. 

The data entered will allow the investigator to create statistical graphs such as histogram, bar charts, Tukey box plots, line graphs, and scatterplots to give a visual representation of the collected data[A7] . The investigator expects that the CUSP intervention groups will have a level of statistical significance of lower CLABSI. CUSP Central line maintenance bundle compliance was measured with the Central line Maintenance Audit Form (appendix B) with the reported standard infection ratio (SIR). The present project shows that the SIR will decrease with the addition of the CHG bathing using inferential statistics.

A Calculation of P-value and paired t-test was completed to compare the means of the sample groups (intervention and nonintervention). Statistical [A8] significance was calculated at a p-value of < .05 at 5.59 or 5% and a 95% confidence interval. Tallied (Table 4) compliance scores from the audit form were entered via SPSS Statistics program to give a percentage of CUSP CVC intervention and non-intervention groups with the number of new CLABSI patients in each group (Heale & Twycross, 2015). SPSS has in-depth statistical capabilities, and the investigator can test Reliability Method Alpha using SPSS, meaning that the same data can be entered several times repeated and whatever the outcome will remain the same or consistent (Ozgur, Kleckner, & Li, 2015). 

The quantitative design will involve CUSP central line audit form (Appendix B) for nurse compliance in the adult ICU hospitals for the application of the CUSP CVC maintenance CHG bathing. The quantitative approach has been successfully used by Ider et al. (2012) to identify compliance with evidence-based guidelines for central line management. 

    

Criterion

Learner Score
   (0, 1, 2, or 3)

Chairperson Score
   (0, 1, 2, or 3)

Comments or Feedback

 

DATA ANALYSIS PROCEDURES

This section presents a description of the   process that was used to analyze the data. If clinical question(s) guided the   project, data analysis procedures can be framed relative to each clinical   question. Data can also be organized by chronology of phenomena, by themes   and patterns, or by other approaches as deemed appropriate according for a   qualitative project. 

1

 

Describes in detail the data analysis   procedures.

1

 

Explains and justifies any differences in   why the data analysis section does not match what was approved in Chapter 3   (if appropriate).

1

 

Provides validity and reliability of the   data in statistical terms for quantitative methodology. Describes approaches   used to ensure validity and reliability for qualitative projects. 

1

 

Identifies sources of error and potential   impact on the data. 

1

 

For a quantitative project, justifies how   the analysis aligns with the clinical question(s) and is appropriate for the   DPI project design. For a qualitative   project justifies how data and findings were organized by chronology of   phenomena, by themes and patterns, or by other approaches as deemed   appropriate.

1

 

Section is written in a way that is well   structured, has a logical flow, uses correct paragraph structure, uses   correct sentence structure, uses correct punctuation, and uses correct APA   format. 

2

 

NOTE: Once the document has been approved by your chairperson and   your committee and is ready to submit for review, please remove all of these   assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs   substantial edits); 2 (present, but needs some editing); 3 (publication   ready).

Results

The focus was placed upon the adverse event of CLABSI infections and the CHG intervention. Table 5 demonstrates the frequency of CLABSI infection events for a year pre CHG intervention and was five occurrences up to this CLABSI [A9] prevention improvement project. The standard deviation (SD) of the sample for the occurrence of CLABSI after CHG intervention was calculated as the SD of 21.68, with a sample variance of 470. The SD of the sample of occurrences of CLABSI without the CHG intervention was calculated at 0.49 with a sample variance of 0.24. The frequency of CLABSI for the 12 months before the CHG intervention and the month post-intervention is displayed in Table 5. The most frequently occurring CLABSI events occurred pre CHG intervention in October 2018 with one reported, January 2019 with one reported, May 2019, with one reported, August 2019, with one reported, and October with one reported[A10] . The median frequency of occurrence for total reported adverse events was 1:6 or 0[A11] .16 events per month. 

There was no identified trend for ide

Assignment 1: Gastrointestinal Tract: Disorders of Motility

 

Assignment 1: Gastrointestinal Tract: Disorders of Motility

Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned.

Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.

To Prepare

  • Review the gastrointestinal system.
  • Identify the normal pathophysiology of gastric acid stimulation and production.
  • Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.

To Complete

Write a 3-page paper that addresses the following:

  • Key Points:
  • A).Describe the normal pathophysiologyof gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.
  • B).Explain how the factor youselected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.

c).Select a patient factor: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.

  • D).Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

Due 01/19/2018 at 1400Hrs…Please see Key points to include in paper:

Statistical Analysis Chapter 4 and 5

I need someone who is good at APA tables and statistical analysis. The information is already in the attachment. The tables and charts must be in APA format   

Chapter 4: Data Analysis and Results

This chapter will review the collected data, evaluate methods used to analyze the data, and appraise the findings of the study. The purpose of this quantitative project was to determine the degree of relationship between the independent variale of nurse’s participation in an evidence-based CLABSI prevention using CHG bathing and the dependent variables of lowering CLABSI rates in patients with CVCs in a healthcare facility in Texas. The quantitative research methodology was selected as a means to review the collected data, evaluate and analyze the data and to appraise the findings of the quality improvement project. The purpose of the project is to explore the problem of CLABSIs and examine available measures to prevent, control, reduce incidences, and to implement a quality improvement project set forth by this investigator to decrease CLABSIs. More importantly, the project seeks to contribute to the field of evidence-based practices in nursing by showing the role of the nurse in helping to reduce HAIs, such as CLABSIs, in the adult critical care setting. In particular, the present project proposes nurse training on the CUSP toolkit and additional CLABSI maintenance, including CHG bathing as an intervention to prevent CLABSI. Central line Venous Catheters (CVCs) are commonly used for inpatients hospitalized in acute care Intensive Care Units (ICU) to administer blood products, intravenous fluids, parenteral nutrition, and other types of medications, such as antibiotics. The use of catheters is, however, linked to the risk of developing a hospital-acquired infection (HAI), known as Central-line Associated Bloodstream Infection (CLABSI) mainly caused by microorganisms found on the external surface of the patient’s skin, improper hand hygiene, or in the fluid pathway post-catheter insertion. Notably, CVCs have been cited as the most frequent and costliest causes of bloodstream infections (Haddadin & Regunath., 2019). CLABSI prevention is one of seven requirements by the Joint Commission for hospitals to accredited nursing care centers and listed as a National Patient Safety Goal (NPSG) NPSG.07.04.01 (Yokoe et al., 2018).

Evidence-based practices, including CHG bathing, adequate hand hygiene, and clear de-escalation protocols for central lines that are no longer medically necessary, were utilized. The Comprehensive Unit-based Safety Program (CUSP) is a program designed to teach and enhance patient safety awareness as well as the quality of nursing care (Basinger, 2015). The project will implement CUSP, which is comprised of five basic steps. The CUSP process starts with providing education on the CUSP Central-line maintenance bundle that includes chlorohexidine gluconate (CHG) bathing, followed by the identification of weaknesses and risks in patient safety, then the partnering of a senior executive of the critical care unit, learning from the flaws, and the execution of communication and teamwork tools (Basinger, 2015). The core CUSP toolkit (appendix B) gives clinical teams the training resources and tools to apply the CUSP CHG bathing intervention for this project to prevent CLABSIs.

The present project will consist of audit tools on awareness and compliance, like the AHRQ CUSP CLABSI Central Line Maintenance Audit Form and CUSP toolkit (appendix B) in which proper maintenance of CLABSI is ensured (Baldassarre, Finkelston, Decker, Lewis, & Niesley, 2015). A CUSP CLABSI maintenance audit tool (Appendix B) was used on the nurses providing care on those patients with CVCs were used within the adult ICU at Texas hospital, to help in determining the CLASBI maintenance bundle compliance. The results of the project were analyzed using the necessary statistical methods to help in establishing the conclusion of the results. The Texas hospital’s nursing data portal was used to gather statistical data that will determine if CHG use has helped reach the benchmark goal of SIR = 75th percentile and the Goal Process Measures or KPIs = 90% compliance compared to other hospitals in the division. Currently, in the last quarter of 2019, the benchmark of the 75th percentile has been achieving post quality improvements that include the addition of CHG bathing. CUSP CLABSI maintenance audit tool (Appendix B) (Heale & Twycross, 2015). Statistical significance was calculated at a p-value of < .05 and a 95% confidence interval. The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) developed and used standardized infection ratios (SIRs) to measure healthcare-associated infection (HAI) incidence (Soe, Gould, Pollock, & Edwards, 2015). 

The Infection rate is calculated using the overall percentage of infection by dividing the number of new cases by the average census and multiplying by 100. For more specific rates, the number will be provided by dividing the number of new cases by the total resident days and multiply by 1000, which gives you the number of infections per 1000 resident days (Liu et al., 2016). Standardized Infection Ratio (SRI) is expressed as a ratio and is the comparison of the actual number of HAIs to the predicted number of HAIs in a healthcare organization. This value is based upon data reported to National Healthcare Safety Network (NHSN) during a specified time period. The Hospital Corporation of America’s (HCA) goal is 75th percentile. A SIR can only be calculated if there is at least one predicted infection

Goal: SIR = 75th percentile

To assist in determining if patient outcomes could be improved using simulation 

activities, a rural healthcare facility in Southeast Texas, was chosen to conduct the project. The methodology used for this project was quantitative. A quantitative methodology was chosen to provide absolute value to the rate of incidence or occurrence of adverse events to support measurement of the difference between pre- and post-simulation intervention. A quasi-experimental design was used as participants were not randomly selected. This approach suited the request of the institution to include nurses working in the ED. 

Using comparative analysis, the CUSP CLABSI Central Line Maintenance Audit Form (appendix B) shows > 90 percent compliance, the data met the key performance indicators (KPIs) for a decrease in CLABSI and it’s compliance with evidence based standars has brought down CLABSI infection rates. The Goal Process Measures or KPIs (key performance indicators) = 90% compliance. The bullet graph (Table 1) at the top right corner of Nursing Data Portal trending screens, outlines how to read and interpret progress on performance milestones. The purpose of this chapter is to summarize the collected data, how it was analyzed, and then to present the results. 

Table 1

Table 1 shows the Hospital KPI performance graph on CHG bathing from the organization’s Nursing Data Portal. The table shows the prior month and current month percentage labeled 0% to 100%. Moving from left to right, the graph shows the organization’s divisional average at 50% and next the HCA corporate average of 70%. Aspiration goals for CHG bathing are set for the 75th percentile with higher aspirational goals set at 100% or in the 90th percentile. 

Table 2[A1] 

In the present project, a CVC maintenance bundle checklist (Appendix D) was used to observe nurses in the adult ICUs of an acute Texas hospital. The observation will involve the Central Line Audit Form (Appendix B) comparing nurse’s compliance regarding CVC maintenance and any significant definite statistical decrease in the reported standardize infection rates and was done for one month (Table 3). In 2019 in the first two quarters, the facility has already reported 20 HAIs, according to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) (Painter, 2018). From May to September (five-month trend) the Texas hospital was at 96% overall performance, and the division in which it belongs, the Gulf Coast Division, was at 97% with the goal of overall performance being 98% of all HCA hospitals (Table 2). [A2] The next five-month trend from August to November, the Texas hospital was at 95% overall performance, and the division in which it belongs, the Gulf Coast Division, was at 89% with the goal of overall performance being 98% of all HCA hospitals (Table 2). CLABSI infection and prevention are a factor in the overall performance both at the local, division and national levels. Other size hospitals in Texas have an average of 15 CLABSI per year (Liu et al., 2016). The present project will apply the quantitative approach, which was used in data collection and analysis. The present project will consist of audit tools on awareness and compliance, like the AHRQ CUSP CLABSI Central Line Maintenance Audit Form and CUSP toolkit (appendix B) in which maintenance of CLABSI is ensured (Baldassarre, Finkelston, Decker, Lewis, & Niesley, 2015). A CUSP CLABSI Central Line Maintenance Audit Form (appendix B) on the nurses providing care on those patients with CVCs was used within the adult ICU at Texas hospital, to help in determining CLASBI maintenance CHG bathing compliance. The results of the project were analyzed using the necessary statistical methods to help in establishing the conclusion of the results. CUSP CLABSI maintenance audit tool (Appendix B) (Heale & Twycross, 2015). Statistical significance was calculated at a p-value of < .05 at 5.59 or 5% and a 95% confidence interval. The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety [A3] Network (NHSN) developed and used standardized infection ratios (SIRs) to measure healthcare-associated infection (HAI) incidence (Soe, Gould, Pollock, & Edwards, 2015). The Infection rate calculation calculated using the overall percentage of infection by dividing the number of new cases by the average census and multiplying by 100. For more specific rates, divide the number of new cases by total resident days and multiply by [A4] 1000, which gives you the number of infections per 1000 resident days (Liu et al., 2016). Using comparative analysis, if the CUSP CLABSI Central Line Maintenance Audit Form (appendix B) shows 90 percent compliance, the data met the KPIs for a decrease in CLABSI. In the present project, a CVC maintenance bundle checklist (Appendix E) was used to observe nurses in the adult ICUs of an acute Texas hospital. The observation involved the Central Line Audit Form (Appendix B) comparing nurses’ compliance regarding [A5] CVC maintenance and any significant definite statistical decrease in the reported standardize infection rates and was done for one month.

The following clinical question will guide this quantitative project: 

Q: In adult patients with central line catheters, how does staff training on the CUSP CLABSIs maintenance CHG bathing to reduce the incidence of CLABSIs (Central Line-Associated Blood-stream Infections) compared to standard care over one month?

Standard care here is defined as procedural pause, aseptic techniques, hand hygiene, and optimal site selection, to protect the insertion site and to take maximal sterile precautions (Advani, Lee, Long, Schmitz, & Camins, 2018).

    

Criterion

Learner Score
 (0, 1, 2, or 3)

Chairperson Score
   (0, 1, 2, or 3)

Comments or Feedback

 

INTRODUCTION (TOTHE CHAPTER)

This section of Chapter 4 briefly restates   the problem statement, the methodology, the clinical question(s) or   phenomena, and offers a statement about what will be covered in this chapter.   

1

 

Re-introduces the purpose of the practice   project.

1

 

Briefly describes the project methodology   and/or clinical question(s) tested.

1

Develop project methodology.

 

Provides an orienting statement about what   will be covered in the chapter.

2

 

Section is written in a way that is well   structured, has a logical flow, uses correct paragraph structure, uses   correct sentence structure, uses correct punctuation, and uses correct APA   format. 

2

 

NOTE:   Once the document has been approved by your chairperson and your committee   and is ready to submit for review, please remove all of these assessment   tables from this document.

Score 0   (not present); 1(unacceptable; needs substantial edits); 2 (present, but   needs some editing); 3 (publication ready).

Descriptive Data

A CHG bath/treatment must be given each day (based off midnight census) for a patient in the adult ICU with a central line, hemodialysis catheter, PICC, midline, or accessed port, and the CHG bath must be documented as per the Texas hospital’s policy. The Texas hospital utilizes Meditech 5.6.x Source System to documents daily CHG bathing (Appendix F). CHG bathing is tracked through the hospital’s Nursing Data Portal, a division-wide analytics program. CHG bathing is tracked through the Texas hospital’s Nursing Data Portal, a division-wide analytics program. This portal can track CHG compliance, date and time of bath, CVC placement, type of lumens, date and time of access, and any reason CHG bathing was not performed (Appendix E) on the CVC patient, both intervention and nonintervention groups were determined via the CUSP CLABSI Maintenance Audit form. 

The CUSP CLABSI Maintenon Audit form asks the following questions: Was the need for a central line for this patient discussed on patient rounds? Was good hand hygiene used by all personnel involved in line care for this patient (i.e., handwashing with soap and water or with alcohol-based hand sanitizes. If the line was percutaneously placed, was this line placed in a recommended site? Was the dressing changed during this shift? Was Chloraprep or 2% chlorhexidine in 70% Isopropyl alcohol used for skin antisepsis? Were central line tubing and all additions (secondary tubing, etc.) changed during this shift? Was there blood return from each lumen? Was chlorhexidine impregnated BioPatch used? Was a chlorhexidine impregnated occlusive dressing used? Was an antibiotic coated catheter used at insertion? What will you change to improve line maintenance practices? (Appendix B and E). 

A CHG bath/treatment must be given each day for a patient in the ICU with a central line, hemodialysis catheter, PICC, midline, or accessed port, and the CHG bath must be documented in Meditech 5.6x. per the Texas hospital’s policy. From the nursing data portal, this project  the project investigator was able to gather statistical data that determined that CHG use has helped reach the goal of SIR = 75th percentile and the Goal Process Measures or KPIs of 90% compliance. Tallied scores (Table 4) were entered into SPSS Statistics program to give a percentage of CUSP CVC intervention and non-intervention groups with the number of new CLABSI patients in each group. This KPI was determined by a decrease in CLABSI rates. Occurrences of events constitute discrete data and are recorded in whole numbers and into various categories (Ali & Bhaskar, 2016). Entered in the SPSS program was the independent variable, which is all the nurses in the present project. This group was further divided into two variables an intervention group and a non-intervention group. The intervention group being nurses implementing CUSP CLABSI maintenance bundle CHG bathing and non-interventional group nurses who are attending patients without CHG bathing. All 60 comprised of 30 nurses in each group were coded in Camel case and number, for example, Nurs1 to maintain confidentiality. Dependent variables or numberof infections entered into the SPPS program the quantitative CUSP CLABSI maintenance CHG bathing intervention performed in the adult ICU at Texas hospital. Data entered will allow the investigator to create statistical graphs such as histogram, bar charts, Tukey box plots, line graphs, and scatterplots to give a visual representation of the collected data. The investigator expects that the CUSP intervention groups will have a level of statistical significance of lower CLABSI. CUSP Central line maintenance bundle compliance was measured with the CUSP CLABSI Central line Maintenance Audit Form (appendix B) with the reported standard infection ratio (SIR). The present project shows that the SIR will decrease with the addition of the CHG bathing, and using inferential statistics.

Calculation of the p-value and paired t-test was completed to compare the means of the sample groups (intervention and nonintervention) (Table 3). Statistical significance was calculated at a p-value of < .05 and a 95% confidence interval. Tallied compliance scores from the CUSP CVC audit form were entered SPSS Statistics program to give a percentage of CUSP CVC intervention and non-intervention groups with the number of new CLABSI patients in each group.

The information filled in the audit (Appendix B) were collected and coded to help in carrying out an unbiased de-identified analysis (See Table 4). The coded data were analyzed using the SPSS software to assist in getting the quantitative aspects of the data (Mihas, 2019). Calculation of standard deviation, p-value, and paired t-test was completed to compare the means of the sample groups. Statistical significance was calculated at a p-value of < .05 and a 95% confidence interval. Statistical tests are used to see if the difference between the number of actual infections, and the number of predicted infections are due to just chance alone. If it is doubtful that the difference is due to chance, then the difference is called “statistically significant.” If the SIR is less than 1, and the finding is statistically significant, then the facility’s performance is labeled “Better than Expected.” If the SIR is greater than 1, and the finding is statistically significant, then the facility’s performance is labeled “Worse than Expected.” If the SIR is not statistically significant, then the facility’s SIR is “In the expected range” (Saman & Kavanagh, 2013). When the predicted number of infections is less than 1, then the numbers are too small to compare.” Equally, the investigator used descriptive aspects of the data to assist in making meaning out of any complex scientific elements of the data. The analysis of the data is critical clinically in achieving the objective of the project and answering the clinical questions regarding CLABSI prevention and CHG maintenance (Saman & Kavanagh, 2013). 

Table 3

   

CHG Audit Dates

30-days pre- intervention

CHG Intervention 

No CHG Intervention

No of Infection

with CHG Intervention

No of Infection

without CHG Intervention

SIR 

Standard Infection Ratio

 

10/15-10/21

0

0

1

1

1

 

10/22-10/28

0

0

1

0

1

 

10/29-11/4

0

0

0

1

0

 

11/5-11/14

0

0

0

1

0

 

Mean

0

0

0.5

0.75

0.5

 

Standard Deviation

0

0

0

0.4

0

 

 

CHG Audit Dates

30-days poet-intervention

CHG Intervention 

No CHG Intervention

No of Infection

with Intervention

No of Infection

without Intervention

SIR

Standard Infection Ratio

 

11/15 -11/21

42

18

0

1

1

 

11/22 – 11/28

47

13

0

1

1

 

11/29-12/06

51

9

0

0

< 1

 

12/07 – 12/15

58

2

0

0

< 1

 

Mean

51.6

10.5

0

0.5

 

Standard Deviation

6.7

5.9

0

0.5

                

CVC/ PICC Line Days –     Current Census for Clear Lake (Campus: Clear Lake)

Date_______________

 

      

Nurse

De-identified

(Nurs1-Nurs60)

Location

ICU/NTICU/CCU

/CVICU

Patient

De-identified

(P1-P30)

Admit Date

Insertion Site

Location

Right/Left

Type

of Catheter

Start Date

CUSP

Audit

CHG Bath

(Y/N[A6] )

 

Nurs1

G.ICU

P1

ARM

RIGHT

CVC multi lumen double

Y

 

Nurs2

G.ICU

P2

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs3

G.ICU

P3

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs4

G.ICU

P4

ARM

RIGHT

Dialysis catheter triple

N

 

Nurs5

G.ICU

P5

ARM

LEFT

CVC multi lumen triple

N

 

Nurs6

G.ICU

P6

ARM

LEFT

CVC multi lumen triple

Y

 

Nurs7

G.ICU

P7

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs8

G.ICU

P8

ARM

LEFT

CVC multi lumen triple

N

 

Nurs9

G.ICU

P9

ARM

LEFT

Dialysis catheter triple

N

 

Nurs10

G.ICU

P10

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs11

G.ICU

P11

ARM

LEFT

Dialysis catheter triple

N

 

Nurs12

G.ICU

P12

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs13

G.ICU

P13

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs14

G.ICU

P14

ARM

RIGHT

CVC multi lumen double

Y

 

Nurs15

G.ICU

P15

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs16

G.ICU

P16

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs17

G.ICU

P17

ARM

RIGHT

Midline

Y

 

Nurs18

G.ICU

P18

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs19

G.ICU

P19

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs20

G.ICU

P20

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs21

G.ICU

P21

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs22

G.ICU

P22

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs23

G.ICU

P23

ARM

LEFT

CVC multi lumen double

Y

 

Nurs24

G.ICU

P24

ARM

RIGHT

Dialysis catheter triple

N

 

Nurs25

G.ICU

P25

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs26

G.ICU

P26

ARM

RIGHT

Midline

Y

 

Nurs27

G.ICU

P27

ARM

RIGHT

CVC multi lumen triple

N

 

Nurs28

G.ICU

P28

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs29

G.ICU

P29

ARM

LEFT

Dialysis catheter triple

N

 

Nurs30

G.ICU

P30

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs31

G.ICU

P31

ARM

LEFT

Dialysis catheter triple

N

 

Nurs32

G.ICU

P32

ARM

LEFT

CVC multi lumen triple

N

 

Nurs33

G.ICU

P33

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs34

G.ICU

P34

ARM

LEFT

CVC multi lumen double

Y

 

Nurs35

G.ICU

P35

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs36

G.ICU

P36

ARM

LEFT

CVC multi lumen triple

Y

 

Nurs37

G.ICU

P37

ARM

RIGHT

Midline

N

 

Nurs38

G.ICU

P38

ARM

CVC multi-lumen triple

N

 

Nurs39

G.ICU

P39

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs40

G.ICU

P40

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs41

G.ICU

P41

ARM

RIGHT

CVC multi lumen triple

N

 

Nurs42

G.ICU

P42

ARM

RIGHT

Dialysis catheter triple

N

 

Nurs43

G.ICU

P42

ARM

LEFT

CVC multi lumen double

N

 

Nurs44

G.ICU

P43

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs45

G.ICU

P44

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs46

G.ICU

P45

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs47

G.ICU

P46

ARM

LEFT

Dialysis catheter triple

N

 

Nurs48

G.ICU

P47

ARM

LEFT

CVC multi lumen triple

N

 

Nurs49

G.ICU

P48

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs50

G.ICU

P50

ARM

RIGHT

CVC multi lumen double

N

 

Nurs51

G.ICU

P51

ARM

LEFT

Dialysis catheter triple

Y

 

Nurs52

G.ICU

P52

ARM

RIGHT

CVC multi lumen triple

N

 

Nurs53

G.ICU

P53

ARM

LEFT

Midline

Y

 

Nurs54

G.ICU

P54

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs55

G.ICU

P55

ARM

RIGHT

Dialysis catheter triple

N

 

Nurs56

G.ICU

P56

ARM

RIGHT

Dialysis catheter triple

Y

 

Nurs57

G.ICU

P57

ARM

RIGHT

CVC multi lumen triple

Y

 

Nurs58

G.ICU

P58

ARM

RIGHT

Dialysis catheter triple

N

 

Nurs59

G.ICU

P59

ARM

RIGHT

CVC multi lumen double

Y

 

Nurs60

G.ICU

P60

ARM

LEFT

Dialysis catheter triple

N

Table 4

    

Criterion

Learner Score
   (0, 1, 2, or 3)

Chairperson Score
   (0, 1, 2, or 3)

Comments or Feedback

 

DESCRIPTIVE DATA

This section of Chapter 4 provides a narrative summary of the population or sample   characteristics and demographics of the   participants in the project. It establishes the number of subjects, gender,   age, level (if appropriate), organization, or setting (if appropriate). The   use of graphic organizers, such as tables, charts and graphs to provide   further clarification and promote readability, is encouraged. 

1

 

Provides a narrative summary of the   population or sample characteristics and demographics.

1

 

Graphic organizers are used as appropriate   to organize and present coded data, as well as descriptive data such as   tables, histograms, graphs, and/or charts.

1

 

Section is written in a way that is well   structured, has a logical flow, uses correct paragraph structure, uses   correct sentence structure, uses correct punctuation, and uses correct APA   format. 

1

 

NOTE: Once the document has been approved by your chairperson and   your committee and is ready to submit for review, please remove all of these assessment   tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2   (present, but needs some editing); 3 (publication ready).

Data Analysis Procedures

A quantitative approach has been successfully used by McKim (2016) to identify barriers to compliance with evidence-based guidelines for central line management. The main objective of using this approach is to strengthen and/or expand conclusions, thereby contributing to existing knowledge. The approach helps to heighten knowledge and increase the validity of the results (Guetterman, Fetters & Creswell, 2015).

Reliability was addressed by ensuring that the instrument is consistent. The CUSP CLABSI Maintenance Central line audit was collected and coded to help in carrying out an unbiased analysis. The coded data were analyzed using the SPSS software to assist in obtaining the quality improvement aspects of the data (Mihas, 2019). Data were entered into the SPSS program were the independent variable, which is all the nurses in the present project. This group was further divided into two variables an intervention group and a non-intervention group. The intervention group being nurses implementing CUSP CLABSI maintenance bundle CHG bathing and non-interventional group nurses who are attending patients without CHG bathing. All 60 nurses 30 in each group were coded in Camel case and number, for example, Nurs1 to maintain confidentiality. Dependent variables or numberof infections entered into the SPPS program the quantitative CUSP CLABSI maintenance CHG bathing intervention performed in the adult ICU at Texas hospital. 

The data entered will allow the investigator to create statistical graphs such as histogram, bar charts, Tukey box plots, line graphs, and scatterplots to give a visual representation of the collected data[A7] . The investigator expects that the CUSP intervention groups will have a level of statistical significance of lower CLABSI. CUSP Central line maintenance bundle compliance was measured with the Central line Maintenance Audit Form (appendix B) with the reported standard infection ratio (SIR). The present project shows that the SIR will decrease with the addition of the CHG bathing using inferential statistics.

A Calculation of P-value and paired t-test was completed to compare the means of the sample groups (intervention and nonintervention). Statistical [A8] significance was calculated at a p-value of < .05 at 5.59 or 5% and a 95% confidence interval. Tallied (Table 4) compliance scores from the audit form were entered via SPSS Statistics program to give a percentage of CUSP CVC intervention and non-intervention groups with the number of new CLABSI patients in each group (Heale & Twycross, 2015). SPSS has in-depth statistical capabilities, and the investigator can test Reliability Method Alpha using SPSS, meaning that the same data can be entered several times repeated and whatever the outcome will remain the same or consistent (Ozgur, Kleckner, & Li, 2015). 

The quantitative design will involve CUSP central line audit form (Appendix B) for nurse compliance in the adult ICU hospitals for the application of the CUSP CVC maintenance CHG bathing. The quantitative approach has been successfully used by Ider et al. (2012) to identify compliance with evidence-based guidelines for central line management. 

    

Criterion

Learner Score
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Chairperson Score
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Comments or Feedback

 

DATA ANALYSIS PROCEDURES

This section presents a description of the   process that was used to analyze the data. If clinical question(s) guided the   project, data analysis procedures can be framed relative to each clinical   question. Data can also be organized by chronology of phenomena, by themes   and patterns, or by other approaches as deemed appropriate according for a   qualitative project. 

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Describes in detail the data analysis   procedures.

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Explains and justifies any differences in   why the data analysis section does not match what was approved in Chapter 3   (if appropriate).

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Provides validity and reliability of the   data in statistical terms for quantitative methodology. Describes approaches   used to ensure validity and reliability for qualitative projects. 

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Identifies sources of error and potential   impact on the data. 

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For a quantitative project, justifies how   the analysis aligns with the clinical question(s) and is appropriate for the   DPI project design. For a qualitative   project justifies how data and findings were organized by chronology of   phenomena, by themes and patterns, or by other approaches as deemed   appropriate.

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Section is written in a way that is well   structured, has a logical flow, uses correct paragraph structure, uses   correct sentence structure, uses correct punctuation, and uses correct APA   format. 

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NOTE: Once the document has been approved by your chairperson and   your committee and is ready to submit for review, please remove all of these   assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs   substantial edits); 2 (present, but needs some editing); 3 (publication   ready).

Results

The focus was placed upon the adverse event of CLABSI infections and the CHG intervention. Table 5 demonstrates the frequency of CLABSI infection events for a year pre CHG intervention and was five occurrences up to this CLABSI [A9] prevention improvement project. The standard deviation (SD) of the sample for the occurrence of CLABSI after CHG intervention was calculated as the SD of 21.68, with a sample variance of 470. The SD of the sample of occurrences of CLABSI without the CHG intervention was calculated at 0.49 with a sample variance of 0.24. The frequency of CLABSI for the 12 months before the CHG intervention and the month post-intervention is displayed in Table 5. The most frequently occurring CLABSI events occurred pre CHG intervention in October 2018 with one reported, January 2019 with one reported, May 2019, with one reported, August 2019, with one reported, and October with one reported[A10] . The median frequency of occurrence for total reported adverse events was 1:6 or 0[A11] .16 events per month. 

There was no identified trend for ide

In this Assignment, you will apply the information you have learned regarding boundaries and dual relationships to the analysis of a real life scenario.

Boundaries and Dual Relationships

In this Assignment, you will apply the information you have learned regarding boundaries and dual relationships to the analysis of a real life scenario.

Assignment Scenario

Ms. Cheney was a case manager at an outpatient clinic that provided a variety of services. One of her clients was Ms. Rosalind, who was receiving services because of a recent divorce. Ms. Cheney had also experienced a divorce in her past and thought she had effectively dealt with that experience, but found herself identifying with many comments made by Ms. Rosalind.

Through their work together, the two women realized they shared many common interests. They often found themselves talking about these shared interests in their time together and eventually began meeting for coffee after their sessions. Ms. Rosalind soon suggested they begin spending additional time together socially and Ms. Cheney agreed. Before long, they became fast friends, spending a significant amount of social time together on evenings and weekends, visiting clubs, going to movies or visiting local restaurants.

After several months, the two had a falling out about a gentleman both women favored. Ms. Rosalind filed a complaint with the Regulatory agency in her state about the relationship.

Assignment Directions

Please be sure to address all of the following in your Assignment:

  • Introduce the case study and analyze the implications of the events in the scenario.
  • Investigate the harmful effects of such a relationship on all parties involved: Ms. Rosalind, the helping relationship, and for Ms. Cheney.
  • Discuss both the social and emotional impacts of such a relationship as well as their effects on the treatment relationship. Use specific examples.
  • Discuss the likely outcome of Ms. Rosalind’s complaint if it was filed in your state.
  • Discuss strategies to minimize the likelihood of such a relationship arising in your practice.

Assignment Guidelines

Your Assignment should be a 3–4 page expository essay, not including the title and reference pages, and should include the following elements:

  • Title page: Provide your name, title of Assignment, course and section number, and date
  • Body: Answer all the questions in complete sentences and paragraphs
    • Your responses should reflect professional writing standards using proper tone and language. The writing and writing style should be correct, accurate, and reflect knowledge of professional ethics and personal values in the human service profession.
  • Reference page: Sources in APA format
    • Include a minimum of two scholarly or academic sources to support your responses and conclusions
  • Use Arial or Times New Roman 12-point font, double-spaced, and left aligned
  • Use standard 1″ margins on all sides
  • Use APA Formatting and Citation style

Write a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice.

QUESTION
JUL 08, 2019

In this assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

  1. Select an issue from the following list: bullying, unit closers and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.
  2. Describe the selected issue. Discuss how it impacts quality of care and patient safety in the setting in which it occurs.
  3. Discuss how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct.
  4. Explain the differing roles of nursing leaders and nursing managers in this instance and discuss the different approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
  5. Discuss what additional aspects mangers and leaders would need to initiate in order to ensure professionalism throughout diverse health care settings while addressing the selected issue.
  6. Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.

Use at least three peer-reviewed journal articles other than those presented in your text or provided in the course.

Prepare this assignment according to the guidelines found in the APA Style Guide.