Concept And Theories Of Nursing IV

Economics Assignment

Economics Assignment

Economics Assignment

Subsystem: Economics

1. Review the following resources:

a. Course textbook and/or other assigned readings

b. Review social determinants of health

c. Review your selected Sentinel City (SC) neighborhood demographics.

d. Meet with Mayor Hill who can provide some information about Sentinel City® economics in general.

2. Enter SC® and begin the bus tour. Compare your selected community to the city in general.

3. As you tour the neighborhood, note signs that indicate your neighborhood is a community that is “thriving” or just “surviving”. Note indicators of high or low employment. Consider education levels, number of female head of households, and median household incomes.

4. Select a specific population group with in your community and identify one of the most common diseases, chronic condition, or injury that impacts this population group.

5. Using an evidence-based approach, address levels of prevention in relation to the disease, chronic condition, or injury that impacts a specific population group. Identify economic prevention strategies that can be initiated by nurses and other healthcare providers and propose an action or intervention that addresses the disease, condition, or injury that most impacts your selected population group.

6. For questions, contact your Academic Coach.

Subsystem: Economics
Primary Prevention Actions or interventions used to reduce exposure or vulnerability to a health issue or concern prior to disease onset or diagnosis. Think: health promotion and disease prevention	Secondary Prevention Actions or interventions used to detect or treat a health issue/concern in early stages to prevent progression or recurrence. Think early and periodic screenings.	Tertiary Prevention Actions or interventions used to limit disability and/or enhance rehabilitation for a disease or injury. Think rehabilitation, occupational or physical therapy.
Population Group:	Disease, Chronic Condition, or Injury:
Proposed Action or Intervention:	Proposed Action or Intervention:	Proposed Action or Intervention:
Evidence-based rationale of how this action or intervention will decrease healthcare costs. Include the citation here and reference on the reference page	Evidence-based rationale of how this action or intervention will decrease healthcare costs. Include the citation here and reference on the reference page	Evidence-based rationale of how this action or intervention will decrease healthcare costs. Include the citation here and reference on the reference page

References

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Myra Levine (Grand Theory)

Please, before you respond to the following prompts refer to the attached PowerPoint.

This is based on the PowerPoint (Myra Levine) you did for me last week.

Please respond to the following prompts:

1. Describe your thoughts on the grand theory about which your group presented.

2. What were the challenges that you faced in understanding the theory?

3. How did you attempt to resolve those challenges?

– Your initial post should contain two to three (2–3) paragraphs of three to four (3–4) sentences per paragraph.

– Integrate a minimum of three readings and/or other evidence-based research articles no more than three years old.

– Use APA formatting for citations and references.

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Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

Change Implementation And Management Plan

 

Change Implementation And Management PlanChange Implementation And Management Plan

Change Implementation and Management Plan

It is one of the most cliché of clichés, but it nevertheless rings true: The only constant changes. As a nursing professional, you are no doubt aware that success in the healthcare field requires the ability to adapt to change, as the pace of change in healthcare may be without rival.

As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.

To Prepare:

• Review the Resources and identify one change that you believe is called for in your organization/workplace.
  • This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.
• Reflect on how you might implement this change and how you might communicate this change to organizational leadership.

The Assignment (5-6-minute narrated PowerPoint presentation):

Change Implementation and Management Plan

Create a narrated PowerPoint presentation of 5 or 6 slides with video that presents a comprehensive plan to implement the change you propose.

Your narrated presentation should be 5–6 minutes in length.

Your Change Implementation and Management Plan should include the following:

• An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)
• A description of the change being proposed
• Justifications for the change, including why addressing it will have a positive impact on your organization/workplace
• Details about the type and scope of the proposed change
• Identification of the stakeholders impacted by the change
• Identification of a change management team (by title/role)
• A plan for communicating the change you propose
• A description of risk mitigation plans you would recommend to address the risks anticipated by the change you proposeWORKPLACE ENVIRONMENT ASSESSMENT 2

  WORKPLACE ENVIRONMENT ASSESSMENT 3

  Running head: WORKPLACE ENVIRONMENT ASSESSMENT

  Workplace Environment Assessment

  Interprofessional Organizational and Systems Leadership, NURS-6053N

  Workplace Environment Assessment

  Work climate evaluation is vital to ensure an awareness of the situation at work. It offers a detailed description of the current environments that require an assessment to make it comfortable and suitable for work. The existing working environments inspire the organization’s success and overall service quality.

  Purpose Statement

  The paper discusses the outcomes of the organizational assessment, theoretical context, and approaches presented in the literature review, which address the shortcomings arising from the evaluation.

  Part 1 Workplace Assessment: Results

  Workplace climate appraisal offered an incentive to observe the organization’s standards of civility. The assessment of the Clark Safe Workplace Inventory measures the circumstances existing and has generated varied outcomes. The findings revealed no direct, polite, and straightforward dialogue at all levels; the workers regarded it as a means to an end, and there was little proof of cooperation and coordination. Several community leaders emphasized that they would not consider the organization an ideal place to operate with families and friends. Notwithstanding shortcomings, the review shows that the organization hires and maintains even the finest and brightest workers, promoting a free exchange of views, although they oppose it (Clark, 2015).

  Major Issues

  Teamwork and teamwork and excellent communication are essential across the entire team. It was disturbing to notice that this was a concern not only in my unit but also for the organization as a whole. Such actions are counter to the organizational philosophy, which aims to promote cooperation and coordination, and constructive communication to facilitate the accomplishment of personal corporate and employee goals. Here are the concerns I’ve checked in my unit from my previous evaluation.

  Workplace Civility

  The assessment findings have indicated that there is little civility within the company. A company with a philosophy of civility encourages workers’ wellbeing and treats them with respect rather than a means to an end. It also promotes cooperation, coordination, and efficient contact.

  Part 2: Reviewing Literature

  The literature analysis showed that honest leadership, efficient management, successful decision-making, sufficient personnel, teamwork, and substantive appreciation are essential in fostering a safe work environment (Ramdhani, Ramdhani & Ainissyifa, 2017). Clark (2015) Further notes that joint mission and team values, respect for individual and organizational civility, civility exchanges at various levels, and emphasis on formal and informal leadership are essential in promoting a safe work environment.

  Corporate culture requires leadership preparation, acceptance, and incentives, team building, and collaboration. Workplace culture has a significant influence on the actions of the employee. Ramdhani et al. (2017) state that members will be able to promote open communication with workers, allowing them to address complaints. Also, many workers are reluctant to fix incivility because they feel that it can change(Ramdhani et al., 2017). However, to express their opinions, they need to train themselves properly to discuss the matters of concern. In establishing a protected environment, representing agreeing and checking, they will do so.

  How it relates to Selected Articles

  Articles in the literature review also put a greater focus on fostering a corporate culture that respects good cooperation, coordination, mutual interests, partnership, which are the significant triggers of incivility found from the study. However, papers in the literature review focused mainly on promoting a business culture that values strong teamwork, collaboration, shared goals, relationships, which are the leading incivility causes observed in the report (Clark, 2015).

  Organizational Health Improvement

  The company would benefit significantly from the analytical structure provided in a study of the literature. The awareness generated would assist in the decision-making process and implement appropriate measures to affect the enterprise’s culture. The organization has to strengthen coordination and connectivity and cooperation (Ramdhani et al., 2017). However, this can only happen When they tend to consider the employee as associates instead of subjects (Yan & Li, 2017). The organization has to improve collaboration through the use of team-building practices.

  Part 3: Evidence-based Strategies for High-performance Interprofessional Team

  Strategies to Improve Shortfalls

  A person should consider a safe space and self-reflection while discussing successful communication problems and stressing collaboration. The shift is an incremental cycle that begins with any person in an organization (Gluyas, 2015). Therefore, the evolution of corporate culture that encourages collaboration and efficient communication will continue to improve the employee’s interest. Self-reflection is not necessary for the providing of service to the company but personal development. The probability of preserving culture is strong when introduced by the staff (Brazdauskaite & Rasimaviciene, 2015).

  Upon assessing and considering it capable of the desired improvement, they will find a secure place to express the company’s desired change. The shift may be introduced from the different organizational units via daily meetings and elevated to the top management (Nagy &

  Curl-Nagy, 2019). On the planned changes, the senior management will then call the team heads.

  Strategies to Bolster Successful Practices

  The effective behaviors in the organization can strengthen through enhancing a conducive working environment in the organization. The organization found to retain qualified employees; this can improve if they make the working conditions more favorable for them (Kent, Goetzel, Roemer, Prasad & Freundlich,2016). Enhancement of working conditions can achieve through addressing issues of communication and appreciation of their work.

  Individuals given the freedom to express themselves on particular ideas of concern to them; this does not only promote the advocacy process. The organization can enhance and promote freedom of expression through joint meetings and equal delegation of duties. These changes will offer the employee the opportunity to learn how they can advocate their issues that are not conducive to the organization. Besides, through these forums, the employee can be equipped with skills in conflict resolution.

  Summary

  Assessment in the workforce helps with recognizing the differences, an effort to minimize them. Teamwork and teamwork and efficient contact are areas of corporate importance. Discussing these problems boost the organization’s civility. The literature review has emphasized that coordination, cooperation, and valuable communication are essential elements of an organization. The outcome of the conversation will affect the decision-making process and policy development to enhance interpersonal civility. Self-reflection and proper planning will reduce the shortfalls. The transition should start with an employee, then scale up to senior management through the unit members. Aspects that are successful in the organization, by making the workplace more comfortable, will change.

  Conclusion

  Assessment in the workforce provides the ability to evaluate the company’s situation, equipping a person with organizational shortcomings and strengths. The issues facing a single agency are impacting the whole company. To maintain a safe work environment, excellent communication, coordination, cooperation, and acknowledgment of employee contributions are essential. Therefore they should be supported by a company through evidence-based activities such as open collaboration, enhancing interprofessional relationships, and a favorable working climate.

  References

  Brazdauskaite, G., & Rasimaviciene, D. (2015). Towards the creative university: Developing a conceptual framework for transdisciplinary teamwork. Journal of Creativity and Business Innovation, (1).

  Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. Am Nurs

  Today, 10.

  Gluyas, H. (2015). Effective communication and teamwork promotes patient safety. Nursing

  Standard (2014+), 29(49), 50.

  Kent, K., Goetzel, R. Z., Roemer, E. C., Prasad, A., & Freundlich, N. (2016). Promoting healthy workplaces by building cultures of health and applying strategic communications. Journal of occupational and environmental medicine, 58(2), 114-122.

  Nagy, M. S., & Curl-Nagy, D. J. (2019). Workplace civility training: An antidote to traditional sexual harassment training. Industrial and Organizational Psychology,12(01), 93-95. doi:10.1017/iop.2019.16

  Ramdhani, A., Ramdhani, M. A., & Ainissyifa, H. (2017). Conceptual Framework of Corporate

  Culture Influenced on Employees Commitment to Organization. International Business Management, 11(3), 826-830.

  Yan, Y., & Li, J. (2017). Beyond incivility in the workplace: Using civility interventions to proactively deescalate workplace incivility. Advances in Psychological Science,25(2),

  319. doi:10.3724/sp.j.1042.2017.00319

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The Role Of The Nurse Informaticists In Systems Development And Implementation

Informaticists In Systems Development And Implementation

Assume you are a nurse manager on a unit where a new nursing documentation system is to be implemented. You want to ensure that the system will be usable and acceptable for the nurses impacted. You realize a nurse leader must be on the implementation team.

To Prepare:

• Review the steps of the Systems Development Life Cycle (SDLC) and reflect on the scenario presented.
• Consider the benefits and challenges associated with involving a nurse leader on an implementation team for health information technology.

The Assignment: (2-3 pages)

In preparation of filling this role, develop a 2- to 3-page role description for a graduate-level nurse to guide his/her participation on the implementation team. The role description should be based on the SDLC stages and tasks and should clearly define how this individual will participate in and impact each of the following steps:

• Planning and requirements definition
• Analysis
• Design of the new system
• Implementation
• Post-implementation support

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Soap Note For Patient With Psoriasis

Complete the template attached (See File 1) according to the example (See File 2 )   

                     It is mandatory that you respect the information requested in the template

              You should not modify the template. The titles and subtitles will be verified

             

2)¨******APA norms

            Dont write in the first person 

Dont copy and pase the questions.

Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

3) It will be verified by Turnitin and SafeAssign

4) Minimum 5 references not older than 5 years

_______________________________________________________________

Purpose:  create soap note for patient with Psoriasis

Create a clinical case of a patient diagnosed with Psoriasis. Based on the case you created, complete the Template.

Miami Regional University

Date of Encounter:

Preceptor/Clinical Site:

Clinical Instructor:

Soap Note # Main Diagnosis ( Exp: Soap Note #3 DX: Hypertension)

PATIENT INFORMATION

Name: Mr. DT

Age: 68-year-old

Gender at Birth: Male

Gender Identity: Male

Source: Patient

Allergies: PCN, Iodine

Current Medications:

· Atorvastatin tab 20 mg, 1-tab PO at bedtime

· ASA 81mg po daily

· Multi-Vitamin Centrum Silver

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Preventive Care: Coloscopy 5 years ago (Negative)

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social History: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

Sexual Orientation: Straight

Nutrition History: Diets off and on, Does not each seafood

Subjective Data:

Chief Complaint: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month. Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

Review of Systems (ROS)

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizziness as describe above. Denies changes in LOC. Denies history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

RESPIRATORY: Patient denies shortness of breath, cough or hemoptysis.

CARDIOVASCULAR: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

GASTROINTESTINAL: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or

diarrhea.

GENITOURINARY: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

SKIN: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data:

VITAL SIGNS: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 2/10.

GENERAL APPREARANCE: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,. Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

CARDIOVASCULAR: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

RESPIRATORY: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

GASTROINTESTINAL: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation

MUSKULOSKELETAL: No pain to palpation. Active and passive ROM within normal limits, no stiffness.

INTEGUMENTARY: intact, no lesions or rashes, no cyanosis or jaundice.

ASSESSMENT:

Main Diagnosis

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed (Codina Leik, 2015). Diagnosis is based on the clinical evaluation through history,ical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease (Domino et al,. 2017).

Differential diagnosis:

· Renal artery stenosis (ICD10 I70.1)

· Chronic kidney disease (ICD10 I12.9)

· Hyperthyroidism (ICD10 E05.90)

PLAN:

Labs and Diagnostic Test to be ordered:

· CMP

· Complete blood count (CBC)

· Lipid profile

· Thyroid-stimulating hormone (TSH)

· Urinalysis with Micro

· Electrocardiogram (EKG 12 lead)

Pharmacological treatment:

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

· Lisinopril 10mg PO Daily

Non-Pharmacologic treatment:

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring log at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance.

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Follow up appointment 1 weeks for managing blood pressure and to evaluate current hypotensive therapy.

· No referrals needed at this time.

References

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.).

ISBN 978-0-8261-3424-0

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017

(25th ed.). Print (The 5-Minute Consult Series).

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Power Point Questions

This is a Collaborative Learning Community (CLC) assignment.

Nursing theories are tested and systematic ways to implement nursing practice. Select a nursing theory and its conceptual model. Prepare a 10‐15 slide PowerPoint in which you describe the nursing theory and its conceptual model and demonstrate its application in nursing practice. Include the following:

1. Present an overview of the nursing theory. Provide evidence that demonstrates support for the model’s efficacy in nursing practice. Explain how the theory proves the conceptual model.
2. Explain how the nursing theory incorporates the four metaparadigm concepts.
3. Provide three evidence‐based examples that demonstrate how the nursing theory supports nursing practice. Provide support and rationale for each.

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

NGS6420 Week 10 Final Exam Guide

NGS6420 Week 10 Final Exam Guide

NGS6420 Week 10 Final Exam Guide

Question

Question 1. You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism?

Moist and smooth

Moist and rough

Dry and smooth

Dry and rough

Question 2. Question : You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or noninflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process?

Tenderness

Cool temperature

Ecchymosis

Nodules

Question 3. Question : A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?

Actinic keratosis

Seborrheic keratosis

Basal cell carcinoma

Squamous cell carcinoma

Question 4. Question : A 28-year-old graduate student comes to your clinic for evaluation of pain “all over.” With further questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints. She states that the pain is worse in the morning. There is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation. Muscle strength and range of motion are normal. Which one of the following is likely the cause of her pain?

Rheumatoid arthritis

Osteoarthritis

Fibromyalgia

Polymyalgia rheumatica

Question 5. Question : Heberden’s nodes are commonly found in which one of the following diseases?

Rheumatoid arthritis

Degenerative joint disease

Psoriatic arthritis

Septic arthritis

Question 6. Question : A new patient is complaining of severe pruritus that is worse at night. Several family members also have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and on the axillae. This finding is most consistent with:

Contact dermatitis

Impetigo

Larva migrans

Scabies

Question 7. Question : An obese 55-year-old woman went through menarche at age 16 and menopause 2 years ago. She is concerned because an aunt had severe osteoporosis. Which one of the following is a risk factor for osteoporosis?

Obesity

Late menopause

Having an aunt with osteoporosis

Delayed menarche

Question 8. Question : Ms. Whiting is a 68-year-old female who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do?

Conclude that these are lesions she has had for a long time.

Wait for her to mention them before asking further questions.

Ask how she acquired them.

Conduct the visit as usual for the patient.

Question 9. Question : A 58-year-old man comes to your office complaining of bilateral back pain that now awakens him at night. This has been steadily increasing for the past 2 months. Which one of the following is the most reassuring in this patient with back pain?

: Age over 50

Pain at night

Pain lasting more than 1 month or not responding to therapy

Pain that is bilateral

Question 10. Question : The Phalen’s test is used to evaluate:

Inflammation of the median nerve

Rheumatoid arthritis

Degenerative joint changes

Chronic tenosynovitis

1. Question : Which of the following would lead you to suspect a hydrocele versus other causes of scrotal swelling?

The presence of bowel sounds in the scrotum

Being unable to palpate superior to the mass

A positive transillumination test

Normal thickness of the skin of the scrotum

Question 2. Question : You are examining a newborn and note that the right testicle is not in the scrotum. What should you do next?

Refer to urology

Recheck in six months

Tell the parent the testicle is absent but that this should not affect fertility

Attempt to bring down the testis from the inguinal canal

Question 3. Question : A 50-year-old truck driver comes to your clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system complaints. His past medical history is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different trucking company. He smokes one pack of cigarettes a day, drinks less than six beers a week, and denies using any illegal drugs. His mother has high blood pressure and arthritis and his father died of lung cancer in his sixties. On examination, his blood pressure is 130/80 and his pulse is 80. His cardiac, lung, and abdominal examinations are normal. He has no inguinal hernia, but on his digital rectal examination you palpate a soft, smooth, and nontender pedunculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation?

Internal hemorrhoid

Prostate cancer

Anorectal cancer

Rectal polyp

Question 4. Question : A 15-year-old high school football player is brought to your office by his mother. He is complaining of severe testicular pain since exactly 8:00 this morning. He denies any sexual activity and states that he hurts so bad he can’t even urinate. He is nauseated and is throwing up. He denies any recent illness or fever. His past medical history is unremarkable. He denies any tobacco, alcohol, or drug use. His parents are both in good health. On examination, you see a young teenager lying on the bed with an emesis basin. He is very uncomfortable and keeps shifting his position. His blood pressure is 150/100, his pulse is 110, and his respirations are 24. On visualization of the penis, he is circumcised and there are no lesions and no discharge from the meatus. His scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the patient begins to cry. His prostate examination is unremarkable. His cremasteric reflex is absent on the left but is normal on the right. By catheter you get a urine sample and the analysis is unremarkable. You send the boy with his mother to the emergency room for further workup.

Acute orchitis

Acute epididymitis

Torsion of the spermatic cord

Prostatitis

Question 5. Question : Which is true of prostate cancer?

It is commonly lethal.

It is one of the less common forms of cancer.

Family history does not appear to be a risk factor.

Ethnicity is a risk factor.

Question 6. Question : Which of the following conditions involves a tight prepuce which, once retracted, cannot be returned?

Phimosis

Paraphimosis

Balanitis

Balanoposthitis

Question 7. Question : A 12-year-old is brought to your clinic by his father. He was taught in his health class at school to do monthly testicular self-examinations. Yesterday, when he felt his left testicle, it was enlarged and tender. He isn’t sure if he has had burning with urination and he says he has never had sexual intercourse. He has had a sore throat, cough, and runny nose for the last three days. His past medical history is significant for a tonsillectomy as a small child. His father has high blood pressure and his mother is healthy. On examination, you see a child in no acute distress. His temperature is 100.8 and his blood pressure and pulse are unremarkable. On visualization of his penis, he is uncircumcised and has no lesions or discharge. His scrotum is red and tense on the left and normal appearing on the right. Palpating his left testicle reveals a mildly sore swollen testicle. The right testicle is unremarkable. An examining finger is put through both inguinal rings, and there are no bulges with bearing down. His prostate examination is unremarkable. Urine analysis is also unremarkable. What abnormality of the testes does this child most likely have?

Acute orchitis

Acute epididymitis

Torsion of the spermatic cord

Prostatitis

Question 8. Question : The most common cause of cancer deaths in males is:

Lung cancer

Prostate cancer

Colon cancer

Skin cancer

Question 9. Question : Important techniques in performing the rectal examination include which of the following?

Lubrication

Waiting for the sphincter to relax

Explaining what the patient should expect with each step before it occurs

All of the above

Question 10. Question : Jim is a 47-year-old man who is having difficulties with sexual function. He is recently separated from his wife of 20 years. He notes that he has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem?

Decreased testosterone levels

Psychological issues

Abnormal hypogastric arterial circulation

Impaired neural innervation

Question 1. Which of the following is true of human papilloma virus (HPV) infection?

Pap smear is a relatively ineffective screening method.

It commonly resolves spontaneously in one to two years.

It is the second most common STI in the United States.

HPV infections cause a small but important number of cervical cancers.

Question 2. Question : Which of the following is the most effective pattern of palpation for breast cancer?

Beginning at the nipple, make an ever-enlarging spiral.

Divide the breast into quadrants and inspect each systematically.

Examine in lines resembling the back and forth pattern of mowing a lawn.

Beginning at the nipple, palpate vertically in a stripe pattern.

Question 3. Question : A 14-year-old junior high school student is brought in by his mother and father because he seems to be developing breasts. The mother is upset because she read on the Internet that smoking marijuana leads to breast enlargement in males. The young man adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is unremarkable. His parents are both in good health. He has two older brothers who never had this problem. On examination, you see a mildly overweight teenager with enlarged breast tissue that is slightly tender on both sides. Otherwise, his examination is normal. He is agreeable to taking a drug test. What is the most likely cause of his gynecomastia?

Breast cancer

Imbalance of hormones of puberty

Drug use

Question 4. Question : Which of the following represents metrorrhagia?

Fewer than 21 days between menses

Excessive flow

Infrequent bleeding

Bleeding between periods

Question 5. Question : What does a KOH (potassium hydroxide) prep help the nurse practitioner diagnose?

Herpes zoster infections

Yeast infections

Herpes simplex infections

Viral infections

Question 6. Question : Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true?

This is most likely due to lack of lubrication.

This is most likely due to atrophic vaginitis.

This is most likely due to pressure on an ovary.

Psychosocial reasons may cause this condition.

Question 7. Question : A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no diagnosis of breast cancer in his first-degree relatives. What is the most likely diagnosis?

Breast tissue

Fibrocystic disease

Breast cancer

Lymph node

Question 8. Question : Which of the following is true regarding breast self-examination?

It has been shown to reduce mortality from breast cancer.

It is recommended unanimously by organizations making screening recommendations.

A high proportion of breast masses are detected by breast self-examination.

The undue fear caused by finding a mass justifies omitting instruction in breast self-examination.

Question 9. Question : A 23-year-old computer programmer comes to your office for an annual examination. She has recently become sexually active and wants to be placed on birth control. Her only complaint is that the skin in her armpits has become darker. She states it looks like dirt, and she scrubs her skin nightly with soap and water but the color stays. Her past medical symptoms consist of acne and mild obesity. Her periods have been irregular for 3 years. Her mother has type 2 diabetes, and her father has high blood pressure. The patient denies using tobacco but has four to five drinks on Friday and Saturday nights. She denies any illegal drug use. On examination, you see a mildly obese female who is breathing comfortably. Her vital signs are unremarkable. Looking under her axilla, you see dark, velvet-like skin. Her annual examination is otherwise unremarkable. What disorder of the breast or axilla is she most likely to have?

Peau d’orange

Acanthosis nigricans

Hidradenitis suppurativa

Question 10. Question : Which of the following is true of women who have had a unilateral mastectomy?

They no longer require breast examination.

They should be examined carefully along the surgical scar for masses.

Lymphedema of the ipsilateral arm usually suggests recurrence of breast cancer.

Women with breast reconstruction over their mastectomy site no longer require examination.

Question 1. A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about three days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, three days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over fifty years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination, he appears his stated age and is in no acute distress. His temperature is 100.9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative.His prostate is slightly enlarged but his testicular, penile, and inguinal  examinations are all normal. Blood work is pending.

What diagnosis for abdominal pain best describes his symptoms and signs?

Acute diverticulitis

Acute cholecystitis

Acute appendicitis

Mesenteric ischemia

Question 2. Question : Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for two days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?

Bleeding from a diverticulum

Bleeding from a peptic ulcer

Bleeding from a colon cancer

Bleeding from cholecystitis

Question 3. Question : A 26-year-old sports store manager comes to your clinic, complaining of severe right-sided abdominal pain for twelve hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was the night before and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination, he appears ill and is lying on his right side. His temperature is 100.4 degrees and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one-third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant (RLQ). His rectal, inguinal, prostate, penile, and testicular examinations are normal.

What is the most likely cause of his pain?

Acute appendicitis

Acute mechanical intestinal obstruction

Acute cholecystitis

Mesenteric ischemia

Question 4. Question : Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?

His spleen is definitely enlarged and further workup is warranted.

His spleen is possibly enlarged and close attention should be paid to further examination.

His spleen is possibly enlarged and further workup is warranted.

His spleen is definitely normal.

Question 5. Question : Diminished radial pulses may be seen in patients with which of the following?

Aortic insufficiency

Hyperthyroidism

Arterial emboli

Early “warm” septic shock

Question 6. Question : A 42-year-old florist comes to your office, complaining of chronic constipation for the last six months. She has had no nausea, vomiting, or diarrhea, and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems (ROS), you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination, she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons.

What is the best choice for the cause of her constipation?

Large bowel obstruction

Irritable bowel syndrome

Rectal cancer

Hypothyroidism

Question 7. Question : A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of sixteen, but is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?

Intermittent claudication

Chest pressure with exertion

Shortness of breath

Knee pain

Question 8. Question : You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient’s pain make you concerned for this disease process?

Thigh

Knee

Calf

Ankle

Question 9. Question : A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms?

Femoral pulse, popliteal pulse

Dorsalis pedis pulse, posterior tibial pulse

Carotid pulse

Radial pulse, brachial pulse

Question 10. Question : Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant (LUQ) pain. On examination of this area, a rough grating noise is heard. What is this sound?

It is a splenic rub.

It is a variant of bowel noise.

It represents borborygmi.

It is a vascular noise.

Question 1.A 30-year-old woman with a history of mitral valve problems states that she has been “very tired.” She has started waking up at night and feels like her “heart is pounding.” During the assessment, the nurse practitioner palpates a thrill and lift at the fifth left intercostal space midclavicular line. In the same area the nurse practitioner also auscultates a blowing, swishing sound right after S1. These findings would be most consistent with:

heart failure.

aortic stenosis.

pulmonary edema.

mitral regurgitation.

Question 2. Question : A patient presents with excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that lasts about 1/2 to 2 hours, occurring once or twice each day. The nurse practitioner suspects:

hypertension.

cluster headaches.

tension headaches.

migraine headaches.

Question 3. Question : A patient complains that while studying for an examination he began to notice a severe headache in the frontotemporal area of his head that is throbbing and is somewhat relieved when he lies down. He tells the nurse practitioner that his mother also had these headaches. The nurse practitioner suspects that he may be suffering from:

hypertension.

cluster headaches.

tension headaches.

migraine headaches.

Question 4. Question : A patient tells the nurse practitioner that he is very nervous, that he is nauseated, and that he “feels hot.” This type of data would be:

objective.

reflective.

subjective.

introspective

Question 5. Question : The most important reason to share information and offer brief teaching while performing the physical examination is to help:

the examiner feel more comfortable and gain control of the situation.

build rapport and increase the patient’s confidence in the examiner.

the patient understand his or her disease process and treatment modalities.

the patient identify questions about his or her disease and potential areas of patient education.

Question 6. Question : A patient says that she has recently noticed a lump in the front of her neck below her “Adam’s apple” that seems to be getting bigger. During the assessment, the finding that reassures the nurse practitioner that this may not be a cancerous thyroid nodule is that the lump (nodule):

is tender.

is mobile and not hard.

disappears when the patient smiles.

is hard and fixed to the surrounding structures.

Question 7. Question : A patient visits the clinic because he has recently noticed that the left side of his mouth is paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse practitioner suspects that he has:

Cushing’s syndrome.

Parkinson’s syndrome.

Bell’s palsy.

had a cerebrovascular accident (stroke).

Question 8. Question : The temporomandibular joint is just below the temporal artery and anterior to the:

hyoid.

vagus.

tragus.

mandible.

Question 9. Question : During an examination of a patient’s abdomen, the nurse practitioner notes that the abdomen is rounded and firm to the touch. During percussion, the nurse practitioner notes a drum-like quality of the sound across the quadrants. This type of sound indicates:

constipation.

air-filled areas.

the presence of a tumor.

the presence of dense organs.

Question 10. Question : A patient tells the nurse that he is allergic to penicillin. What would be the nurse practitioner’s best response to this information?

“Are you allergic to any other drugs?”

“How often have you received penicillin?”

“I’ll write your allergy on your chart so you won’t receive any.”

“Please describe what happens to you when you take penicillin.”

Question 11. Question : A patient’s thyroid is enlarged, and the nurse practitioner is preparing to auscultate the thyroid for the presence of a bruit. A bruit is a:

low gurgling sound best heard with the diaphragm of the stethoscope.

loud, whooshing, blowing sound best heard with the bell of the stethoscope.

soft, whooshing, pulsatile sound best heard with the bell of the stethoscope.

high-pitched tinkling sound best heard with the diaphragm of the stethoscope.

Question 12. Question : After completing an initial assessment on a patient, the nurse practitioner has documented that his respirations are eupneic and his pulse is 58. This type of data would be:

objective.

reflective.

subjective.

introspective.

Question 13. Question : A patient tells the nurse that she has had abdominal pain for the past week. What would be the best response by the nurse?

“Can you point to where it hurts?”

“We’ll talk more about that later in the interview.”

“What have you had to eat in the last 24 hours?”

“Have you ever had any surgeries on your abdomen?”

Question 14. Question : A teenage patient comes to the emergency department with complaints of an inability to “breathe and a sharp pain in my left chest.” The assessment findings include the following: cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. This description is consistent with:

bronchitis.

a pneumothorax.

acute pneumonia.

an asthmatic attack.

Question 15. Question : The inspection phase of the physical assessment:

yields little information.

takes time and reveals a surprising amount of information.

may be somewhat uncomfortable for the expert practitioner.

requires a quick glance at the patient’s body systems before proceeding on with palpation.

Question 16. Question : The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. What would be an appropriate response by the nurse practitioner?

“It is unusual for a small child to have frequent ear infections unless there is something else wrong.”

“We need to check the immune system of your son to see why he is having so many ear infections.”

“Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear.”

“Your son’s eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily.”

Question 17. Question : The nurse practitioner would use bimanual palpation technique in which situation?

Palpating the thorax of an infant

Palpating the kidneys and uterus

Assessing pulsations and vibrations

Assessing the presence of tenderness and pain

Question 18. Question : The patient’s record, laboratory studies, objective data, and subjective data combine to form the:

database.

admitting data.

financial statement.

discharge summary.

Question 19. Question : When preparing to perform a physical examination on an infant, the examiner should:

have the parent remove all clothing except the diaper on a boy.

instruct the parent to feed the infant immediately before the exam.

encourage the infant to suck on a pacifier during the abdominal exam.

ask the parent to briefly leave the room when assessing the infant’s vital signs.

Question 20. Question : The nurse practitioner notices that an infant has a large, soft lump on the side of his head and that his mother is very concerned. She tells the nurse practitioner that she noticed the lump about 8 hours after her baby’s birth, and that it seems to be getting bigger. One possible explanation for this is:

hydrocephalus.

craniosynostosis.

cephalhematoma.

caput succedaneum.

Question 21. Question : When examining an infant, the nurse practitioner should examine which area first?

Ear

Nose

Throat

Abdomen

Question 22. Question : When preparing to examine a 6-year-old child, which action is most appropriate?

Start with the thorax, abdomen, and genitalia before examining the head.

Avoid talking about the equipment being used because it may increase the child’s anxiety.

Keep in mind that a child this age will have a sense of modesty.

Have the child undress from the waist up.

Question 23. Question : The nurse practitioner is assessing a patient’s skin during an office visit. What is the best technique to use to best assess the patient’s skin temperature?

Use the fingertips because they’re more sensitive to small changes in temperature.

Use the dorsal surface of the hand because the skin is thinner than on the palms.

Use the ulnar portion of the hand because there is increased blood supply that enhances temperature sensitivity.

Use the palmar surface of the hand because it is most sensitive to temperature variations because of increased nerve supply in this area.

Question 24. Question : Percussion notes heard during the abdominal assessment may include:

flatness, resonance, and dullness.

resonance, dullness, and tympany.

tympany, hyperresonance, and dullness.

resonance, hyperresonance, and flatness.

Question 25. Question : The nurse practitioner is assessing a patient for possible peptic ulcer disease and knows that which condition often causes this problem?

Hypertension

Streptococcus infections

History of constipation and frequent laxative use

Frequent use of nonsteroidal anti-inflammatory drugs

Question 1: You are participating in a health fair and performing cholesterol screens. One person has a cholesterol level of 225. She is concerned about her risk for developing heart disease. Which of the following factors is used to estimate the 10-year risk of developing coronary heart disease?

Ethnicity

Alcohol intake

Gender

Asthma

Question 2. Question : You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur?

Upright

Upright, but leaning forward

Supine

Left lateral decubitus

Question 3. Question : You are screening people at the mall as part of a health fair. The first person who comes for screening has a blood pressure of 132/85. How would you categorize this?

Normal

Prehypertension

Stage 1 hypertension

Stage 2 hypertension

Question 4. Question : How should you determine whether a murmur is systolic or diastolic?

Palpate the carotid pulse.

Palpate the radial pulse.

Judge the relative length of systole and diastole by auscultation.

Correlate the murmur with a bedside heart monitor.

Question 5. Question : A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an electrocardiogram (ECG) because of her history of hypertension. You diagnose a previous myocardial infarction and ask her if she had any symptoms related to this.Which of the following symptoms would be more common in this patient’s  age group for an AMI?

Chest pain

Syncope

Pain radiating into the left arm

Pain radiating into the jaw

Question 6. Question : On examination, you find a bounding carotid pulse on a 62-year-old patient. Which murmur should you suspect?

Mitral valve prolapse

Pulmonic stenosis

Tricuspid insufficiency

Aortic insufficiency

Question 7. Question : Which of the following correlates with a sustained, high-amplitude point of maximal impulse (PMI)?

Hyperthyroidism

Anemia

Fever

Hypertension

Question 8. Question : A 68-year-old woman with hypertension and diabetes is seen by the nurse practitioner for a dry cough that worsens at night when she lies in bed. She has shortness of breath, which worsens when she exerts herself. The patient’s pulse rate is 90/min and regular. The patient has gained 6 lbs over the past two months. She is on a nitroglycerine patch and furosemide daily. The explanation for her symptoms is:

Kidney failure

Congestive heart failure

Angiotensin-converting enzyme (ACE) inhibitor induced coughing

Thyroid disease

Question 9. Question : When listening to a soft murmur or bruit, which of the following may be necessary?

Asking the patient to hold their breath.

Asking the patient in the next bed to turn down the TV.

Checking your stethoscope for air leaks.

All of the above.

Question 10. Question : You notice a patient has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely?

Emphysema

Asthma exacerbation

Severe left heart failure

Cardiac tamponade

Question 1. Question : A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these?

Asthma

COPD

Bronchiectasis

Heart failure

Question 2. Question : A sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer.She denies any  recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex.

Pneumonia

COPD

Pleural pain

Left-sided heart failure

Question 3. Question : A patient with long-standing COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next?

Percuss the lower border of the liver.

Measure the span of the liver.

Order a hepatitis panel.

Obtain an ultrasound of the liver.

Question 4. Question : A fifty-five-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should be considered because of her gesture?

Bronchitis

Costochondritis

Pericarditis

Angina pectoris

Question 5. Question : When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?

Bronchitis

Simple asthma

Cystic fibrosis

Heart failure

Question 6. Question : Is the following information subjective or objective? Mr. Mazz has shortness of breath that has persisted for the past ten days; it is worse with activity and relieved by rest.

Subjective

Objective

Question 7. Question : All of the following are implicated in causing chronic cough except:

Chronic bronchitis

Allergic rhinitis

Acute viral upper respiratory infection

Gastroesophageal reflux disease

Question 8. Question : A mother brings her infant to you because of a “rattle” in his chest with breathing. Which of the following would you hear if there is a problem in the upper airway?

Different sounds from the nose and the chest

Asymmetric sounds

Inspiratory sounds

Sounds louder in the lower chest

Question 9. Question : Which of the following is consistent with good percussion technique?

Allow all of the fingers to touch the chest while performing percussion.

Maintain a stiff wrist and hand.

Leave the plexor finger on the pleximeter after each strike.

Strike the pleximeter over the distal interphalangeal joint.

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Evolving Practice Of Nursing And Patient Care Delivery Models

As the country focuses on the restructuring of the U.S. health care delivery system, nurses will continue to play an important role. It is expected that more and more nursing jobs will become available out in the community, and fewer will be available in acute care hospitals.

1. Write an informal presentation (500-700 words) to educate nurses about how the practice of nursing is expected to grow and change. Include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics.
2. Share your presentation with nurse colleagues on your unit or department and ask them to offer their impressions of the anticipated changes to health care delivery and the new role of nurses in hospital settings, communities, clinics, and medical homes.
3. In 800-1,000 words summarize the feedback shared by three nurse colleagues and discuss whether their impressions are consistent with what you have researched about health reform.
4. A minimum of three scholarly references are required for this assignment.

rubrics

 

 

Clearly States How the Practice of Nursing and Patient Delivery Will Evolve, While Addressing Relevant Concepts That Include Continuity or Continuum of Care, Accountable Care Organizations, Medical Homes, and Nurse-Managed Health Clinics

Evidence of Feedback and Forecasting of Nursing Role From Colleagues

EVOLVING PRACTICE OF NURSING AND PATIENT CARE DELIVERY MODELS 1

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EVOLVING PRACTICE OF NURSING AND PATIENT CARE DELIVERY MODELS

Evolving Practice of Nursing and Patient Care Delivery Models

Ishwari Basnet

Grand Canyon University: NRS-440V

February 27th, 2016

Evolving Practice of Nursing and Patient Care Delivery Models

Hello everyone! I Ishwari Basnet,I am a registered nurse and work in medical \surgical\mental health unit for more than ten years. I would like to welcome you all in this informal education session. Today, I would like to discuss about the changing role of nurses and concept of continuum of care and the new health care delivery models such as Accountable Care Organizations (ACOs), medical homes, and nurse -managed health clinics.

Evolving practice of Nursing and Health Care Models

Health care system is changing; it is not just focused on the curative care but the disease prevention and wellness. Also, the new healthcare reform has approach to the development of healthcare delivery models with the changes in nursing role from acute care settings to community health care. Patient Protection and Affordable Care Act (PPACA) formed at 2010 support the establishment of ACOs, medical homes and nurse-managed health clinics; also new payment policies. With the formation of Affordable Care Act (ACA), health has transformed from traditional treating approach to the preventive and wellness. Nurse’s role has also changed from front-line caregiver to the care integrators and coordinators and help in providing the health services to the underserved people. All the health models are focused on the concept of continuity of care which is defined as “a concept involving an integrated system of care that guides and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care” (Evashwick, 1989). It covers the delivery of healthcare over a period of time and for all levels and stages of care. Let’s talk about the three types of health care delivery model.

Accountable Care Organizations (ACOs)

In accordance to the Center for Medicare and Medicaid services, “Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (Cms.gov, n.d.). The ACO is the new unit built by the ACA; the health reform law 2010 which take care of the cost and quality of the care received by the patients. The main aim of ACO is to deliver flawless and high-quality care at the right time to the patients, especially the chronically ill patients. The ACO include the specific group of providers and suppliers assigned by the ACA and they encourage the active participation of nurse practitioners (NPs), clinical nurse specialists (CNSs) etc with physicians and physician assistants. As nursing leadership is encouraged in ACO, registered nurses can lead in quality assurance and develop the improvement initiatives (Nursingworld.org, n.d.).

Medical Home/Health Home

Medical homes (patient-centered medical homes, PCMH), similar to Accountable Care Organizations are primary health care delivery model focused on the deliverance of the primary care that is patient-centered, managed, synchronized, accessible, ample and believe in quality and safety.  “The medical home is not a final destination instead, it is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient’s needs” (Pcpcc.org, n.d.). This medical health model helps in solving the health care costs problem with the support of primary care providers such as physicians, nurse practitioners and certified nurse-midwives. Nurses being front-line healthcare workers play a vital role in this model as they can actively participate in health promotion and disease prevention, order and interpret laboratory tests and other studies and refer the patients who need specialized care.

Nurse-Managed Health Centers (NMHCs)

NMHC is another initiation developed by ACA to promote the primary care, disease prevention and control of chronic conditions in the medically underserved and rural areas of United States. NMHC’s are managed by the nurses that include all the nurse practitioners, clinical nurse specialists, nurse midwives, and public health nurses. They provide many health services especially in the needed communities such as diagnosis and prescription to illness, pre- and post- natal care and referral to specialists (About Nurse-Managed Care, n.d.). This care model maintain the nurse managed clinics with the aim of enhancing access to primary care in the communities of medically underserved and/ or vulnerable populations, boost up the nursing practice and leadership for the nursing students by serving as clinical training sites and maintain the patient and workforce data.

To conclude, ACOs, medical homes and NMHCs are the concept of new health care delivery model created by the ACA to minimize the issues of health care cost and easy access of quality health care. These models are mainly patient-centered, competent, accessible and cost effective. The establishment of these types of health care delivery models has changed the role of nursing and set new parameter for the nurses. Nurses have advanced beyond the role of front-line healthcare workers to become care coordinators, efficiency experts and prove to be the backbone of most of these delivery care models. Nurse play as a care integrators and focused on the continuum care from the acute care to the community health settings through these models. Moreover, with the advancement of health technology and health reforms, preventive base health care has taken the priority than the curative care and nurse role is very important towards preventive health care too. Therefore, the opportunities for the nurses are increasing and the demand of the educated, skilled and professional nurses are vital during this changing time of health care system.

Thank you for hearing me and participating in this session. If you have any queries, please feel free to ask. I would look forward to hearing your opinion.

Thanks!

Summary of the Feedback

After this author gave the presentation, all the nurse colleagues took part in discussion session about the benefits and changes that new health reforms and the health care models brought in health care system of the country. This paper will summarize the feedback received from three colleague nurses and forecast the role of nursing.

Nurses who took the active participation in the discussion have their own point of view regarding the healthcare reforms and change of nursing role. However, majority of the number have similar point of view about my presentation and support the new healthcare reform. They also appreciate the new health care delivery models and the role of nursing in these care models.

‘Nurse A’, BSN nurse graduated from Bangladesh and working here in United States at recent times, talked about her experience she had as a nurse back in Bangladesh. She expressed that it was totally different; nurses are the front-line caregivers and are not allowed to take any decision; only follow the orders of the doctors. The role of nurse in health care system differs according the location and time. The emergence of importance of community health is providing the opportunities to the nurses in developed countries like the USA and this new health reform is being following by many developing countries as well. She is very happy and ambitious with this new healthcare reforms and healthcare models. Moreover, the role of nursing has been changing from the front-line caregiver to the care integrators and from acute care settings to the community. Nurses’ role in community settings is the major advancement in healthcare system such as NMHCs. Nurses can work as a leader of the organization in the community setting with self directed, critical thinking, and independent decision making qualities. She focused on NMHCs, where nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. Therefore, new healthcare reforms help to provide nursing role a new perspective and lead to an innovation healthcare system.

‘Nurse B’ was also very excited about the healthcare reform as it believes on the potential of nurses for the transformation of US health care system. She focused on importance of the new health reform because of increasing chronic disease and cost and also taking on preventive care over the curative care. The new healthcare delivery models (ACOs, NMHCS, medical homes) will enhance the preventive care services leading the management of the chronic diseases in the community settings. This will help in reducing the problem of rising the cost of health services and can make aware about the disease prevention and health promotion. Moreover, preventive care services will require huge number of educated nurse workforce and leadership to improve the community’s health care. She further added up that the nurses are the fundamental to the patient-centered care delivery model. The nurses have the capability of building a strong relationship and coordination with the patients and the health care providers’ team and lead in organizing and functioning of different health care models. According to her, the concept of the new health care delivery model of providing the facilities to the underserved people is commendable.

‘Nurse C’ has different point of view regarding the healthcare reforms and healthcare models. She expressed her anxiety about the quality of the services provided by the hospitals and healthcare models when large number of people will be flooded into it for the treatment. She explained that Affordable Care Act (ACA) will benefit large number of people causing the crowd that will definitely affect the hospitals and health systems to take care of the influx of the new patients. That is increase in administrative cost, much more paper work, disease and care management, over-seeing and time dealing with Medicare for the millions of newly insured patients. She added that increase in number of patient will imply to the must increase in number of healthcare providers and nurses. If the strong and enough approach are not taken for the fulfillment of the need of nurses and healthcare providers then it will directly affect the quality of care. Moreover, it will affect the status and motivation of the existing nurse workforce. Therefore, she highly looked forward for the high-quality of health services provided to the patient that is she believed in quality rather than quantity.

To conclude, nurses are the major part of health care system and the role of nursing has changed and advanced with the implementation of the health care reform and health care delivery system. These types of reforms and models have transformed the entire health care system of the United States from acute care settings to community and benefitted many underserved people. However, knowledge and information of the health reforms should be given to everyone.

References

About Nurse-Managed Care. (n.d.). Retrieved February 24, 2016, from National Nursing Centers Consortium: http://nncc.us/index.php/about-nurse-managed-care

Cms.gov,. (n.d.). Accountable Care Organizations (ACO) – Centers for Medicare & Medicaid Services. Retrieved 23 February 2016, from /orders/www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/

Evashwick, C. (1989). Creating the continuum of care. Health matrix, 7(1), 30-39.

Nursingworld.org,. (n.d.). Accountable Care Organizations. Retrieved 23 February 2016, from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/ACOs

Pcpcc.org,. (n.d.). Defining the Medical Home | Patient-Centered Primary Care Collaborative. Retrieved 24 February 2016, from /orders/www.pcpcc.org/about/medical-home

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