Answer Critical Thinking Questions 1-3 for Chapter 18 on page 526 and Clinical Application Question 1-4 for Chapter 19 on page 557. Answers should be submitted in a word document with any associated references used. 

Answer Critical Thinking Questions 1-3 for Chapter 18 on page 526 and

1) What problem are associated with the use of live attenuated vaccines?

2) Many of the serological tests require a supply of antibodies against pathogens. For example, to test for Salmonella, anti-Salmonella antibodies are mixed with the unknown bacterium. How these antibodies obtained?

3) A test for antibodies against Treponema pallidum uses the antigen cardiolipin and patient’s serum (Suspected of having antibodies). Why do the antibodies react with cardiolipin? What is the disease? 

Clinical Application Question 1-4 for Chapter 19 on page 557

1) Fungal infections such as athlete’s foot are chronic. These fungi degrade skin Keratin but are not invasive and do not produce toxins. Why do you suppose that many of the symptoms of a fungal infection are due to hypersensitivity to the fungus?

2) After working in a mushroom farm for several months, a worker develops these hives, edema, and swelling lymph node

a) What do these symptoms indicate?

b) What mediators cause these symptoms?

c) How many sensitivities to a particular antigen be determined?

d) Other employees do not appear to have any immunological reactions. What could explain this?

(Hint: The allergen is conidiophores from molds growing in the mushroom farm)

3) Physicians administering live, attenuated mumps and measles vaccines prepared in chick embryos are instructed to have epinephrine available. Epinephrine will not treat these viral infections. What is the purpose of keeping this drug on hand?

4) A woman with blood type A+ once received a transfusion of AB+ blood. When she carried a type B+ fetus, the developed hemolytic disease of the newborn. Explain why this fetus developed this condition even though another type B+ fetus in a different type A+ mother was normal

 

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PART 1- ONE PAGE

Advocating for Social Justice

This course has presented the various roles of the public and community health nurse. The media presenters and the course textbook have covered this in depth. As you prepare for this final Discussion, consider what you have read and heard about the future of public health. Reflect on the readings, Web resources, and media presentations presented throughout this course about the role of the nurse in a community/public health setting and vulnerable populations. Then, respond to the following:

•  
• What is the community health nurse’s role in advocating for social justice for vulnerable populations and in eliminating health disparities?
• 
  
  
• How do you see community health care and the role of the community health nurse changing in the future?

Support your response with references from the professional nursing literature

PART 2- ONE PAGE

Week 5: Create a possible Evidenced-Based, Culturally Appropriate Intervention project to improve the health of your community.

Incorporate all information gathered from the community: the population itself, health data, professionals from various disciplines in the community, community assessment, windshield survey, and the literature to propose interventions. Support your plan with scholarly evidence and health data.

This week your instructor wants you to access and appraise culturally-sensitive, research-based interventions to prevent and improve the health of population at risk.  You may be suggesting a new intervention, supporting current interventions in place, or enhance current interventions. Please read about evidenced-based research in your textbook.   

Please address the following in your discussions:

• Share at least two prevention strategies to improve the population at risk that you feel confident are evidenced-based.  Why do you think that? 
• Think in terms of evaluation of outcomes. How would you know the interventions made a difference?
• How would you modify the intervention to ensure it is culturally sensitive and meaningful?

 

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Overview: Peer Review

In the Module 3 Reflection Assignment, you will reflect upon what you have learned about Peer Review Committee processes and Texas Board of Nursing rules as you consider the actions of fictitious nurses and committee members in scenarios. REMEMBER, YOU ARE USING THE TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. Please use the link provided in the assignment for the Texas BON Rule 217.16.

ALSO, THERE ARE 2 PARTS TO THIS ASSIGNMENT. PLEASE MAKE SURE YOU COMPLETE BOTH PARTS.

Refer to your course readings and lectures as you complete the assignment.

Performance Objectives: 

· Apply the Minor Incident Rule to specific incidents.

· Describe the due process protections for a nurse who is peer-reviewed.

Rubric 

Use this rubric to guide your work on the assignment, “Peer Review.”

Task

Accomplished

Proficient

Needs Improvement

Part 1 (a)

 Applying Rule 217.16

   (Total 50 points) 

Lists all the correct 5 criteria, accurately explains application of   criteria clearly. (25 points)

Lists 3 or 4 of the   correct criteria, accurately explains application of these criteria

 (15 points)

Lists 2 applications of criteria.

 10 points)

Incorrectly lists criteria (0   point)

Part   1 (b)

 Reflects upon applications 

   of Rule 217.16

   (Total 25 points) 

Correctly states if nurse should be reported or not reported with 3 substantial sentences. (25 points)

Correctly states if nurse should be reported or not reported with 2 sentences.

 (15 point)

Writes 1 sentence.

 (10 points)

Incorrectly judges whether violations occurred (0 point)

Part   2

Violation of IBPR Rule 217.19 (Total   25 points)

Correctly listed the 4 violations and provides correct explanations (25 points)

Correctly lists 2-3 violations and explanations (15 points)

Lists 1 violation and explanation (10 points)

Incorrectly lists criteria (0 point)

All 5 questions correct (25 points)

4 questions correct (20 points)

3 questions correct (15 points)

2 questions correct (10 points)

1 question correct (5 points)

0 questions correct (0 point)

Part 1: (a) Applying Rule 217.16(h) Minor Incidents

Read the following scenario and then answer the questions that follow:

You are on your hospital’s Peer Review Committee (PRC). You are reviewing Nurse A’s practice. She works on the pediatric unit. In the past, Nurse A has practiced safely without incidents. However, four months ago, Nurse A gave immunizations to five pediatric patients (3 months, 9 months, 2 years, 4 years, and 5 years of age). She used a vial of Hepatitis B vaccine that had been expired for 30 days but still was being stored in the unit refrigerator. She gave the five immunizations within a few minutes of each other, and she got the vial from the refrigerator only once (i.e., She did not take it out and replace it five times). She took responsibility for the errors when she was informed by her unit manager. 

Should Nurse A be reported to the BON?

Let’s review what deems a minor vs. a reportable (NOT minor) incident- 

A minor incident is- 217.16(a)-  as defined under the Texas Nursing Practice Act, Texas Occupations Code §301.401(2), means conduct by a nurse that may be a violation of the Texas Nursing Practice Act or a Board rule but does not indicate the nurse’s continued practice poses a risk of harm to a patient or another person. 

A reportable incident is- 217.16(h)- conduct that falls outside of the definition of a minor incident and must be reported to a PRC or BON.

Apply the Minor Incident Rule to reach and support your decision. This Rule 217.16 can be found at http://www.bon.texas.gov/rr_current/217-16.asp

Use this specific link only- it is the official updated Texas Board of Nursing information. Click on the link and scroll down to the bottom to find the letter (h), where criteria are listed that describes actions that must be reported to the Peer Review Committee or BON.

Criteria. In the first column of the table, list the 5 criteria as it appears in the rule that are essential in determining if an incident is a reportable action. All 5 must be listed for full credit. Then, in the second column, record your explanation as to why or why not the nurse’s actions deem it reportable and therefore harmful to a patient.

Criteria that determine an incident is reportable

Rule 217.16(h)

Explanation of whether or not Nurse A’s actions are minor vs. reportable

Criteria : 

1. 

2. 

3. 

4. 

5. 

Part 1: (b) Report vs. Not Report

Based on the Rule 217.16(h) criteria you listed above, would you report Nurse A to the Board? Please explain why or why not. At least 3 substantial sentences are needed for full credit.:       (Explain below)

Part 2: Applying Rule 217.19 Incident-Based Peer Review 

Read the following scenario and then reflect upon the actions it portrays.:

Last month, the chairperson of your hospital’s Peer Review Committee (PRC) passed you in the hallway and said, “I’m glad I ran into you. You’re going to be peer-reviewed.” The chairperson continued, saying, “Your manager found out that you called the Texas Department of State Health Services two months ago and reported that LVNs were being allowed to do the complete initial assessment on patients. Also, you made some medication errors over the past couple of months. I’ll let you know when the meeting is to occur.” 

You heard nothing more about the PRC meeting. Today, the chairperson came to you and told you that you had been reported to the Texas Board of Nursing. She said, “It was just felt by the work group that you are a troublemaker and lack the skills to practice due to your med errors. I’m also giving you a ‘heads up’ that you are going to be put on suspension for at least three days by your unit manager.”

Applying Rule 217.19, what violations of the rule occurred in the above scenario? 

First, review your learning about incident-based peer review. In the first column of the table, list any 4 criteria from Rule 217.19 that were violated (there are more than 4 to choose from). 

1-

2-

3-

4-

In the second column, explain how each criterion was violated. All 4 boxes must be completed for full credit. Please use the link provided at http://www.bon.texas.gov/rr_current/217-19.asp

Which part of the rule was violated? 

(Subsection number and letter OR descriptive phrase)

(Rule 217.19)

Explanation of violation ( from the 4 criteria above):

1.  

2.  

3.  

4.  

 

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PHARM WEEK 5 QUIZ

Question 1

A nurse who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who express a willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated?

A.            A patient whose stage III pressure ulcer required intravenous antibiotics and a vacuum dressing

B.            A patient with a history of angina who experienced a non-ST wave myocardial infarction

C.            A patient who received treatment for kidney failure due to an overdose of acetaminophen

D.            A patient whose pulmonary embolism was treated with a heparin infusion

1 points  

Question 2

A patient who has been taking buspirone (BuSpar) for 1 week calls the clinic and reports to the nurse that the drug is not working. The patient informs the nurse that she is still having symptoms of anxiety. The nurse will tell the patient that

A.            she will report this to the physician immediately.

B.            it may take up to 6 months for the drug to relieve her anxiety.

C.            optimum relief of anxiety usually occurs after 3 to 4 weeks of treatment.

D.            the drug is not going to work for her and the medication needs to be changed.

1 points  

Question 3

A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation. Before administration of propofol, a priority assessment by the nurse would be to check for a history of

A.            diabetic hyperlipidemia.

B.            increased intraocular pressure.

C.            seizure disorders.

D.            low blood pressure.

1 points  

Question 4

A 39-year-old patient who is having trouble sleeping is beginning drug treatment with zaleplon (Sonata). The nurse will be sure to ask the patient if she is taking

A.            oxycodone (Percodan).

B.            secobarbital (Seconal).

C.            cimetidine (Zantac).

D.            meperidine (Demerol).

1 points  

Question 5

A nurse is caring for a patient who has been admitted with acute cocaine intoxication. Which of the following vital signs would the nurse expect to find initially when assessing the patient?

A.            BP: 130/88, P: 92, R: 28

B.            Blood pressure (BP): 98/50, pulse (P): 120, respirations (R): 40

C.            BP: 170/98, P:110, R: 20

D.            BP: 150/90, P: 80, R: 16

1 points  

Question 6

A nurse is caring for a patient who abuses marijuana. The treatment for marijuana abuse consists mainly of

A.            no nursing action unless the patient experiences a “bad trip.”

B.            nonpharmacologic interventions combined with an exercise program.

C.            aggressive respiratory assistance

D.            drug therapy with bromocriptine (Parlodel).

1 points  

Question 7

A patient is suffering from acute inhalant intoxication. The priority nursing intervention will be to

A.            assess the patient’s psychosocial status.

B.            administer oxygen therapy.

C.            provide an emesis basin.

D.            administer epinephrine.

1 points  

Question 8

A 20-year-old man has begun treatment of the psychotic symptoms of schizophrenia using olanzapine (Zyprexa). Which of the following symptoms would be categorized as a negative symptom of schizophrenia?

A.            Visual hallucinations

B.            Auditory hallucinations

C.            Delusional thinking

D.            Lack of interest in normal activities

1 points  

Question 9

A homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient’s characteristics likely to influence possible treatment with phenytoin?

A.            The patient’s heavy alcohol use will compete with phenytoin for binding sites and he will require a higher-than-normal dose.

B.            The patient’s protein deficit will likely increase the levels of the free drug in his blood.

C.            Phenytoin is contraindicated within 48 hours of alcohol use due to the possibility of paradoxical effects.

D.            The patient will require oral phenytoin rather than intravenous administration.

1 points  

Question 10

The wife of a patient who is taking haloperidol calls the clinic and reports that her husband has taken the first dose of the drug and it is not having a therapeutic effect. An appropriate response by the nurse would be

A.            “I’ll ask the nurse practitioner if the dosage can be increased.”

B.            “Continue the prescribed dose. It may take several days to work.”

C.            “I’ll ask the nurse practitioner if the haloperidol can be discontinued and another drug started.”

D.            “I’ll report this to the nurse practitioner and see if he will add another drug to enhance the effects of the haloperidol.”

1 points  

Question 11

A patient who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by

A.            inhibiting the action of monoamine oxidase.

B.            increasing the effects of the neurotransmitter GABA.

C.            increasing the amount of serotonin available in the synapses.

D.            affecting the regulation of serotonin and norepinephrine in the brain.

1 points  

Question 12

A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine. Repeated doses of Narcan will be necessary because Narcan

A.            has a shorter half-life than morphine.

B.            has less strength in each dose than do individual doses of morphine.

C.            causes the respiratory rate to decrease.

D.            combined with morphine, increases the physiologic action of the morphine.

1 points  

Question 13

A 4-year-old child is brought to the emergency department by her mother. The mother reports that the child has been vomiting, and the nurse notes that the child’s face is flushed and she is diaphoretic. The mother thinks that the child may have swallowed carbachol drops. A diagnosis of cholinergic poisoning is made. Which of the following drugs would be administered?

A.            Nicotine

B.            Cevimeline

C.            Atropine

D.            Acetylcholine

1 points  

Question 14

A patient with mild low back pain has been advised to take acetaminophen. The nurse will inform him that excessive intake of acetaminophen may result in

A.            gastrointestinal distress.

B.            cognitive deficits.

C.            acute renal failure.

D.            liver damage.

1 points  

Question 15

A patient has been hospitalized for treatment of substance abuse after being arrested and jailed for the past 24 hours. The patient is experiencing severe muscle and abdominal cramps, seizures, and acute psychosis due to abrupt withdrawal. Which of the following drug classes is the most likely cause of these severe and potentially fatal withdrawal symptoms?

A.            Amphetamines

B.            Opioids

C.            Benzodiazepines

D.            Sedative–hypnotic drugs

1 points  

Question 16

A 59-year-old woman has presented to a clinic requesting a prescription for lorazepam (Ativan) in order to treat her recurrent anxiety. Her care provider, however, believes that a selective serotonin reuptake inhibitor (SSRI) would be more appropriate. What advantage do SSRIs have over benzodiazepines in the treatment of anxiety?

A.            SSRIs have a more rapid therapeutic effect.

B.            SSRIs require administration once per week, versus daily or twice daily with benzodiazepines.

C.            SSRIs generally have fewer adverse effects.

D.            SSRIs do not require serial blood tests during therapy.

1 points  

Question 17

A 64-year-old-patient has been prescribed lorazepam (Ativan) because of increasing periods of anxiety. The nurse should be careful to assess for

A.            a history of current or past alcohol use.

B.            a diet high in fat.

C.            current nicotine use.

D.            a diet high in carbohydrates.

1 points  

Question 18

Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency?

A.            Restoration of normal sinus rhythm

B.            Resolution of respiratory acidosis

C.            Reduction of severe hypertension

D.            Increased level of consciousness

1 points  

Question 19

A trauma patient has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the patient’s

A.            bowel patterns.

B.            urine specific gravity.

C.            skin integrity.

D.            core body temperature.

1 points  

Question 20

A middle-aged patient was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, his psychiatrist has prescribed phenelzine. When planning this patient’s subsequent care, what nursing diagnosis should the nurse prioritize?

A.            Risk for Injury related to drug–drug interactions or drug–nutrient interactions

B.            Risk for Constipation related to decreased gastrointestinal peristalsis

C.            Risk for Ineffective Peripheral Tissue Perfusion related to cardiovascular effects of phenelzine

D.            Risk for Infection related to immunosuppressive effects of phenelzine

1 points  

Question 21

A nurse works in a sleep disorder clinic and is responsible for administering medications to the patients. Which of the following patients would be most likely to receive zaleplon (Sonata)?

A.            A 20-year-old woman who will take the drug about once a week

B.            A 46-year-old man who receives an antidepressant and needs a sleep aid

C.            A 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep

D.            A 52-year-old woman who needs to fall asleep quickly and stay asleep all night

1 points  

Question 22

A 26-year-old professional began using cocaine recreationally several months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he first used the drug. A nurse should recognize that this pattern exemplifies

A.            drug tolerance.

B.            dependence.

C.            addiction.

D.            withdrawal.

1 points  

Question 23

A postsurgical patient has been provided with a morphine patient-controlled analgesic (PCA) but has expressed her reluctance to use it for fear of becoming addicted. How can the nurse best respond to this patient’s concerns?

A.            “It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction.”

B.            “You don’t need to worry. It’s actually not true that you can get addicted to the medications we use in a hospital setting.”

C.            “It’s important that you accept that your current need to control your pain is more important than fears of becoming addicted.”

D.            “If you do become addicted, we’ll make sure to provide you with the support and resources necessary to help you with your recovery.”

1 points  

Question 24

A patient has been prescribed zolpidem (Ambien) for short-term treatment of insomnia. Which of the following will the nurse include in a teaching plan for this patient? (Select all that apply.)

A.            The drug does not cause sleepiness in the morning.

B.            It is available in both quick-onset and continuous-release oral forms.

C.            The drug should not be used for longer than 1 month.

D.            It should be taken 1 hour to 90 minutes before going to bed.

E.            One of the most common adverse effects of the drug is headache.

1 points  

Question 25

A patient who is experiencing withdrawal from heavy alcohol use have developed psychosis and been treated with haloperidol. Which of the following assessment findings should prompt the care team to assess the patient for neuroleptic malignant syndrome?

A.            The patient develops yellowed sclerae and intense pruritis (itchiness).

B.            The patient demonstrates a significant increase in agitation after being given haloperidol.

C.            The patient develops muscle rigidity and a sudden, high fever.

D.            The patient complains of intense thirst and produces copious amounts of urine.

1 points  

Question 26

A nurse is providing care for a patient who suffered extensive burns to his extremities during a recent industrial accident. Topical lidocaine gel has been ordered to be applied to the surfaces of all his burns in order to achieve adequate pain control. When considering this order, the nurse should be aware that

A.            there is a risk of systemic absorption of the lidocaine through the patient’s traumatized skin.

B.            intravenous lidocaine may be preferable to topical application.

C.            lidocaine must be potentiated with another anesthetic in order to achieve pain control.

D.            pain relief is unlikely to be achieved due to the destruction of nerve endings in the burn site.

1 points  

Question 27

Which of the following drugs used to treat anxiety would be appropriate for a patient who is a school teacher and is concerned about feeling sedated at work?

A.            Lorazepam (Ativan)

B.            Diazepam (Valium)

C.            Alprazolam (Xanax)

D.            Buspirone (BuSpar)

1 points  

Question 28

A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse’s priority assessments?

A.            Liver function studies, pain intensity, and blood glucose level

B.            Pain intensity, respiratory rate, and level of consciousness

C.            Respiratory rate, seizure activity, and electrolytes

D.            Respiratory rate, pain intensity, and mental status

1 points  

Question 29

A male patient has been brought to the emergency department during an episode of status epilepticus. Diazepam is to be administered intravenously. The nurse will be sure to

A.            administer after diluting the drug with gabapentin in intravenous solution.

B.            inject very slowly, no faster than 100 mg/minute.

C.            inject the diazepam very quickly, 15 mg in 10 to15 seconds.

D.            avoid the small veins in the dorsum of the hand or the wrist.

1 points  

Question 30

A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for

                A.            increased secretions.

B.            facial flushing.

C.            dizziness

 

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