Medical-Surgical Certification

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415069

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A 60-year-old male is being treated for a myocardial infarction. While he is progressing well physically, he becomes upset when asked to make independent decisions and he rings the call bell constantly asking for reassurance that he will get well. This psychological response to stress is an example of:

Select the correct answer(s).

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Explanation

This patient is exhibiting dependence in response to stress. Typical psychological responses to stress include: Dependence (the patient has an inability to make decisions, requires constant reassurance, and calls nurses/family frequently), Depression (the patient is withdrawn and sad, fails to take treatments and/or misses appointments, and may be at risk for suicide), Anger (the patient is belligerent, uncooperative, and blames others), Confusion (the patient is forgetful, disoriented, and bewildered), and Passivity (the patient defers to others, feeling he/she has no control)

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The American Geriatrics Society's "Guideline for the Prevention of Falls in Older Persons" recommends (among other things):

Select the correct answer(s).

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Explanation

The American Geriatrics Society's "Guidelines for the Prevention of Falls in Older Persons" includes an assessment of falls, gait and balance and makes a number of recommendations for preventing falls, including visual remediation, exercises for strength and balance, review and possible reduction in medications that cause dizziness or instability, modification of home environment, use of an assistive device, supportive footwear, and control of cardiovascular conditions that may cause dizziness/syncope and thereby precipitate falls.

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Which of the following is part of the 12 leading health indicators outlined in Healthy People 2020?

Select the correct answer(s).

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Explanation

Healthy People 2020 outlines 12 leading health indicators and national objectives to improve health and reduce the risks of disease in order to improve life expectancy and quality of life. Leading health indicators are: 1) access to health services, 2) clinical preventative services, 3) environmental quality, 4) injury and violence, 5) maternal, infant, and child health, 6) mental health, 7) nutrition, physical activity, and obesity, 8) oral health, 9) reproductive and sexual health, 10) social determinants, 11) substance abuse, and 12) tobacco. Additionally, Healthy People 2020 includes 42 focus areas that relate to the 12 leading health indicators.

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Which of the following provides research and funding for the development of evidenced based practice guidelines?

Select the correct answer(s).

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Explanation

The Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health and Human services provides research and funding for the development of evidenced-based practice guidelines. The AHRQ has sponsored the development of surveys for assessment of patient safety and is actively involved in outcomes research. The AHRQ research centers specialize in research related to patient safety, quality improvement, outcomes, assessment of clinical practices and technology, healthcare delivery systems, primary and preventive care, and health care costs.

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A 32-year-old single mother of a 4-year-old child is being discharged after a hysterectomy for cervical cancer. She states she is very depressed because she has lost her job, cannot feed her family, and will soon be homeless. Which referral is most appropriate?

Select the correct answer(s).

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Explanation

Referring the single mother to a social worker is the most appropriate, as social workers have the expertise required to assist a patient to apply for social services, including programs such as Temporary Assistance for Needy Families (TANF) and food stamps. The social worker may be able to help the patient avoid homelessness by assisting her to apply for subsidized or low-cost housing. While the patient may benefit from a referral to a mental health clinic, this will not solve the immediate underlying prblem of food and shelter.

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A patient is being treated for renal disease and exhibits the following: ventricular arrhythmia with increasing ECG changes, weakness with ascending paralysis and hyperreflexia, diarrhea, and increasing confusion. The patient most likely has:

Select the correct answer(s).

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Explanation

Hyperkalemia often occurs with renal disease and is characterized by ventricular arrythmia, weakness with ascending paralysis and hyperreflexia, diarrhea, and confusion. Hypokalemia is characterized by weakness, lethargy, nausea, and vomiting, paresthesias, dysrhythmias (PVCs, flattened T waves), muscle cramps with hyporeflexia, hypotension, and tetany. Hypocalcemia is characterized by tetany, tingling, seizures, altered mental status, and ventricular tachycardia. Hypercalcemia is characterized by increasing muscle weakness with hypotonicity, constipation, anorexia, nausea and vomiting, and bradycardia.

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According to principles of learning , adult learners tend to be:

Select the correct answer(s).

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The Instrumental Activities of Daily Living (IADL) tool includes an assessment of:

Select the correct answer(s).

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According to the World Health Organization pain ladder (sometimes called the "analgesic ladder"), a patient with cancer and mild pain should begin treatment with:

Select the correct answer(s).

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Explanation

A patient with cancer and mild pain (level 1) should begin treatment with acetaminophen or aspirin followed by NSAIDs. Patients should always start with the medication with fewest side effects and then move to stronger medications as necessary. NSAIDs should be used if acetaminophen or aspirin doesn't relieve pain. As patients move up the pain ladder to mild-moderate pain (level 2) codeine (hydrocodone, tramadol, or oxycodone) with adjuvants will be added, and, finally, with moderate-severe pain (level 3), opioids (such as fentanyl, morphine, and oxycodone), are used to control pain.

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The nurse must inform the family of a patient that the patient is dying. Which of the following is an effective strategy?

Select the correct answer(s).

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Explanation

Providing sensitive infortmation to patients or family members should be done slowly rather than quickly so that they have time to digest the information. The nurse should ask if they have any questions and should avoid technical jargon and consider psychosocial implications as well as cultural differences. It's important to respond to people's feelings and discuss follow-up. The nurse should exercide patience, understanding that people respond to bad news in very different ways, including both anger and silence.

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The best time to initiate conflict resolution is:

Select the correct answer(s).

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Explanation

The best time to initiate conflict resolution is when conflict first emerges, but before open conflict and hardening of positions. Resolution steps include allowing both parties to present their side without bias, encouraging cooperation through negotiation and compromise, maintaining focus and avoiding arguments, evaluating the need for renegotiation, a formal resolution process, or a 3rd party mediator, utilizing empathy to diffuse tension, summarizing and outlining key arguments, and avoiding forced resolution if possible.

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The best question to elicit information about a patient's pain is:

Select the correct answer(s).

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Explanation

When asking a patient to describe his/her pain, it is best to use an open-ended type of question that elicits specific information.

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A patient who has been prescribed oral phenytoin (Dilantin) for seizure control should be advised to:

Select the correct answer(s).

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Explanation

Phenytoin may cause gingival hyperplasia, so patients should be advised to carefully maintain dental care and to see dentists regularly. Patients may have monthly blood tests initially but once stabilized blood tests are usually done every six months. Patients should be advised to avoid alcohol entirely when taking any anticonvulsant drug. Stopping anticonvulsant drugs abruptly may trigger rebound seizures, so if adverse effects occur, the patient should be advised to immediately contact the physician for guidance in withdrawing the drug if necessary.

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How do team members usually deal with issues of power?

Select the correct answer(s).

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Explanation

Team members usually observe the leader and determine who controls the meeting and how control is exercised, while beginning to form alliances. Arguing is counterproductive, and following strict rules of discourse may not solve power issues and may be too restictive for small collaborative groups. Group interactions often become less formal as members develop rapport and are more willing to help and support each other to achieve goals. Rotating leadership roles can lead to a lack of focus as styles may vary widely. The leader is responsible for organizing the group, clarifying methods to achieve work, and the means of working together toward a common goal.

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A patient who is supposed to be on a low-carbohydrate diet has gained weight and reports eating frequent convenience foods that are high in carbohydrates. When questioned, the patient is knowledgeable about the diet, but states poor vision and arthritis in her hands make food preparation difficult. The most appropriate referral for the patient is:

Select the correct answer(s).

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Explanation

The most appropriate referral for the patient is an occupational therapist who can help the patient develop strategies and skills needed to compensate for poor vision and arthritis and provide information about adaptive equipment that the patient can use to prepare food. The occupational therapist can help the patient establish goals for independent food preparation and help the patient modify tasks. The occupational therapist may also help the patient learn how to better manage her arthritis to minimize the symptoms.

Medical-Surgical Certification

Question 1 of 1

Time Left

Select the correct answer(s).

(0/0)

Explanation

The American Geriatrics Society's "Guideline for the Prevention of Falls in Older Persons" recommends (among other things):

Select the correct answer(s).

(0/0)

Explanation

Which of the following is part of the 12 leading health indicators outlined in Healthy People 2020?

Select the correct answer(s).

(0/0)

Explanation

Which of the following provides research and funding for the development of evidenced based practice guidelines?

Select the correct answer(s).

(0/0)

Explanation

A 32-year-old single mother of a 4-year-old child is being discharged after a hysterectomy for cervical cancer. She states she is very depressed because she has lost her job, cannot feed her family, and will soon be homeless. Which referral is most appropriate?

Select the correct answer(s).

(0/0)

Explanation

A patient is being treated for renal disease and exhibits the following: ventricular arrhythmia with increasing ECG changes, weakness with ascending paralysis and hyperreflexia, diarrhea, and increasing confusion. The patient most likely has:

Select the correct answer(s).

(0/0)

Explanation

According to principles of learning , adult learners tend to be:

Select the correct answer(s).

(0/0)

The Instrumental Activities of Daily Living (IADL) tool includes an assessment of:

Select the correct answer(s).

(0/0)

According to the World Health Organization pain ladder (sometimes called the "analgesic ladder"), a patient with cancer and mild pain should begin treatment with:

Select the correct answer(s).

(0/0)

Explanation

The nurse must inform the family of a patient that the patient is dying. Which of the following is an effective strategy?

Select the correct answer(s).

(0/0)

Explanation

The best time to initiate conflict resolution is:

Select the correct answer(s).

(0/0)

Explanation

The best question to elicit information about a patient's pain is:

Select the correct answer(s).

(0/0)

Explanation

A patient who has been prescribed oral phenytoin (Dilantin) for seizure control should be advised to:

Select the correct answer(s).

(0/0)

Explanation

How do team members usually deal with issues of power?

Select the correct answer(s).

(0/0)

Explanation

Select the correct answer(s).

(0/0)

Explanation

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