Discussion 1: Social Technologies in the Workplace

 

As a nurse manager, it is imperative to understand how social technologies can impact productivity, peer-to-peer relationships, and patient safety within the workplace. Collaborating with HR to understand policies and the organization’s expectations related to the use of social technologies allows nurse managers to more effectively and appropriately integrate today’s social platforms while mitigating the occurrence of inappropriate behaviors.

For this week’s Discussion, your Instructor will assign you to one of the scenarios below. You will then use that scenario to investigate the social, ethical, and legal ramifications of social technologies.

 

Scenario One: You have recently been promoted to charge nurse for the day shift in your department. As a result of this promotion, your former peers are now reporting directly to you. You have been working in your setting for five years and consider many of these peers to be your friends. The way that one of your friends posts on social media sites has always bothered you. Many times, her comments are inappropriate, discussing her negative feelings about “ignorant superiors” and “annoying patients.” You also know that she frequently accesses these sites for extended periods of time while patients are waiting to be helped. Now that she reports directly to you, how do you address this? If your workplace does not have a formal policy on social media use, how can you adapt her behaviors to align with the expectations of nursing professionalism?

 

Scenario Two: It has been a little over a year since you accepted your nurse management position at a local pediatrics office. Since then, you have observed that many nurses seem uneasy when they work with one of your top physicians. You wonder why so many nurses are hesitant to work with such an experienced physician, particularly since most of your families rave about her dedication and caring nature toward their children. One day, while taking careful observation of your staff, you watch a nurse take out a patient chart and begin to text. The nurse becomes visibly upset as she sees you approach. When you question her about her behavior, she confides that the physician asks all nurses to text patient test results to her. The nurse admits that she feels uncomfortable sending private information via text message and only did so after multiple requests and increasing pressure from the physician. According to ethical and legal guidelines, who is at fault for this error in judgment? Since the nurse is the employee who sent the information, should action be taken against her, against the physician, or against both parties?

 

Scenario Three: A physician in your setting is an avid user of social media. On many of his personal pages, which include blogs about his various outdoor hobbies, he plasters pictures of himself and his friends out drinking. He also tends to post extreme comments about politics and the economy. Many in your setting joke with him about the intensity of his social life, to which he always comments, “Work hard, play hard.” Though his actions are not hurting the morale of the setting, and his posts are always before or after work hours, should anything be said to this physician? In the future, could your setting experience any ramifications because of his presence in social media?

 

Scenario Four: The environment in your critical care unit has always been somewhat hectic. However, over the last few months, the morale in your unit has noticeably deteriorated. You learn that nurses have begun to share mass e-mail chains complaining about unfair scheduling treatment. As the nurse manager, you have always tried your best to schedule staff fairly and even allow them to switch their shifts when personal problems arise. Since your effort to talk with staff individually does not seem to be working, you decide to hold a town hall meeting to openly discuss these issues. As you prepare the meeting announcement, you notice e-mails from your hospital administrator, chief operating officer and director of human resources. All are wondering why their inboxes have been inundated with e-mails from upset nurses in your unit. How do you respond to these e-mails? Furthermore, how should you address this situation to improve the morale of your unit?

To prepare

Review this week’s Learning Resources, focusing on the appropriate and inappropriate use of social technologies in the workplace.

Conduct further research on the social, ethical, and legal issues that result from inappropriate use of social technologies both inside and outside work hours.

For example, what laws protect the privacy and free speech of employees? How can workplaces legally safeguard themselves from various social technology issues such as defamation, misrepresentation, or misuse by individual employees? Of what legal ramifications, such as patient privacy and confidentiality laws, should managers be aware?

 

Reflect on the scenario to which you have been assigned.

How might employee use of social technologies impact the rest of the setting? How might it impact the care given to patients?

 

As the nursing manager who oversees the employee(s), what strategies (if any) would you employ to effectively address this situation?

 

Consider the social technology policies of your past or present workplace.

With regard to employee use of social media, do you believe the workplace policy is effective? Why or why not? As a nurse manager, could you use this policy to effectively address the behaviors in your assigned scenario?

Note: Before you submit your initial post, replace the subject line (“Week 11 Discussion”) with “Review of Case Study ___” identifying the number of the case study you were assigned.

 

Post an explanation of the possible social, ethical, and/or legal ramifications of your assigned scenario. Explain the policy your current or past workplace has on the use of social technologies and how effective you believe the policy is. If your workplace does not have a policy, explain what the accepted practices or expectations are for your setting. Has lack of policy led to any problems? Support your responses by referencing authentic examples from the workplace and this week’s Learning Resources as appropriate.

 

Read a selection of your colleagues’ responses.

 

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence, or research.

Share an insight from having read a colleague’s posting, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional research.

 

Required Readings

 

Manion, J. (2011). From management to leadership: Strategies for transforming health care (3rd ed.). San Francisco, CA: Jossey-Bass.

Chapter 7, “Coaching and Developing Others” (pp. 339–341)

Review the scripting model on these pages. In this chapter, Manion discusses motivation and explains how leaders can make the most of it through coaching. She explains the leader’s role, the coaching role, and the difference between coaching and being a coach.

Alichnie, C. (2012). Social media and nursing. Pennsylvania Nurse, 67(1), 3–10. 

Retrieved from the Walden Library databases.

 

This article discusses the use of social media in nursing. The author determines that social media can be a means to an end if it’s used wisely, professionally, and within legal and ethical boundaries.

Barrett, A., Piatek, C., Korber, S., & Padula, C. (2009). Lessons learned from a lateral violence and team-building intervention. Nursing Administration Quarterly, 33(4), 342–351. 

Retrieved from the Walden Library databases.

 

This study focuses on nurse interaction in relation to lateral violence. The authors conclude that the key to a cohesive work environment is a nurse leader who is able to drive and sustain change.

Barton, S. A., Alamri, M. S., Cella, D., Cherry, K. L., Curll, K., Hallman, B. D., et al. (2011). Dissolving clique behavior. Nursing Management, 42(8), 32–37. 

Retrieved from the Walden Library databases.

 

This article addresses clique behavior in health care settings. The argument is that the current economic climate encourages regression in health care workers.

Brinkert, R. (2010). A literature review of conflict communication causes, costs, benefits and interventions in nursing. Journal of Nursing Management, 18(2), 145–156. 

Retrieved from the Walden Library databases.

 

The author assesses the effects of conflict communication on nursing. The study concludes that conflict will always be a part of nursing but that it can be mitigated if nurse managers use employee-effective intervention methods.

Cronquist, R., & Spector, N. (2011). Nurses and social media: Regulatory concerns and guidelines. Journal of Nursing Regulation, 2(3), 37–40. 

Retrieved from the Walden Library databases.

 

Cronquist and Spector’s article provides nurses with social media guidelines. They also give the reader examples of what happens when social media is used outside of professional, legal, and ethical boundaries.

Greenlund, L. (2011). ED violence: Occupational hazard? Nursing Management, 42(7), 28–32. 

Retrieved from the Walden Library databases.

 

This article analyzes the effects of workplace violence on hospitals’ productivity. Because workplace violence can be costly, the author provides prevention methods.

Hader, R. (2009). Tweeting—not just for the birds. Nursing Management, 40(12), 6. 

Retrieved from the Walden Library databases.

 

This article focuses on what nurse leaders should do about social media in the workplace. New leadership challenges have risen because of this form of communication. Nurse leaders need to ensure that their employees are not violating a patient’s rights to privacy.

Issues & answers. Social media: Implications for nursing: Nursing Practice Statement NP 85. (2011). Ohio Nurses Review, 86(2), 6–7. 

Retrieved from the Walden Library databases

 

This article informs the reader about the laws and rules that apply to nursing and social media. The authors take a stance on the use of social media and list its benefits and drawbacks.

Kuhns, K. A. (2012). Social media and professional nursing: Friend or foe? Pennsylvania Nurse, 67(1), 4–8. 

Retrieved from the Walden Library databases.

 

Kuhn’s article introduces the reader to the many different types of social media and argues that there is more to social media than Facebook and Twitter. The article then goes on to discuss the pros and cons of the use of social media in the workplace.

Macleod, L. (2011). Avoiding “group think”: A manage’s challenge. Nursing Management, 42(10), 44–48. 

Retrieved from the Walden Library databases.

 

Macleod’s article focuses on the increasing costs of health care. He says that changes need to happen both within and outside of health care settings for this change to be sustainable.

Robinson, M.-A. (2012). Closing perspectives: Navigating the world of social media. Alberta RN, 67(6), 42. 

Retrieved from the Walden Library databases.

 

Robinson’s article addresses the hesitation that many organizations have with social networking. While there are professional benefits, there are also risks and new challenges.

 

A 52-year-old African American male presents to an urgent care center complaining of urinary frequency and nocturia. The symptoms have been present for several months and have increased in frequency over the past week. He has been unable to sleep because of the need to urinate at least hourly all day and night. He does not have a primary care provider and has not seen a doctor in more than 10 years. His father died when he was a child in an automobile accident, and his mother is 79 years old and has hypertension. The patient has no siblings. His social history includes the following: banker by profession, divorced father of two grown children, non-smoker, and occasionally consumes alcohol on weekends only.

   Conceptual-Theoretical-Empirical Structure (CTE) Evaluation Assignment

Details:

Conceptual models, theories, and empirical indicators are linked and provide a nursing knowledge system to apply the model or theory to nursing practice, research, and education. Advanced-practice nurses are required to understand the linkages as applied to nursing and translate the components into practice.  To continue development of nursing knowledge, advanced practice nurses can create structure to test theory. 

 

General Guidelines:

•This assignment requires that at least three additional scholarly research articles related to this topic, and at least one in-text citation from each source be included.

•You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

 

Directions:

Write a 1,200-1500 word paper examining how the Conceptual – Theoretical – Empirical (CTE) structure translates into nursing practice based on one of the middle range theories that has been formulated or derived from your preferred conceptual model of nursing. Translate and apply the selected theory to nursing practice using actual examples. Evaluate the theory using the CTE steps below:

1.Evaluation of the conceptual-theoretical-empirical linkages.

2.Evaluation of the selected theory.

3.Evaluation of the empirical indicators.

4.Evaluation of research findings.

5.Evaluation of the utility and soundness of the practice theory.

 

 

Question 1 1 / 1 point

Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with:

Question options:

Topical antipruritics

Oral corticosteroids for 2 to 3 weeks

Thickly applied topical intermediate-dose corticosteroids

Isolation of the patient to prevent spread of the dermatitis

Question 2 1 / 1 point

Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be:

Question options:

PEG 3350 (Miralax)

Bisacodyl (Dulcolax) suppository

Docusate (Colace) suppository

Polyethylene glycol electrolyte solution

Question 3 1 / 1 point

Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for:

Question options:

Iron deficiency anemia, vitamin B12 and calcium deficiency

Folate and magnesium deficiency

Elevated uric acid levels leading to gout

Hypokalemia and hypocalcemia

Question 4 1 / 1 point

The drug of choice for treatment of early latent or tertiary syphilis is:

Question options:

Ceftriaxone IM

Benzathine penicillin G IM

Oral azithromycin

Oral ciprofloxacin

Question 5 0 / 1 point

The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is:

Question options:

2 years

5 years

10 years

15 years

Question 6 1 / 1 point

The Best Pharmaceuticals for Children Act:

Question options:

Includes a pediatric exclusivity rule which extends the patent on drugs studied in children

Establishes a committee that writes guidelines for pediatric prescribing

Provides funding for new drug development aimed at children

Encourages manufacturers specifically to develop pediatric formulations

Question 7 1 / 1 point

Sophie presents to the clinic with a malodorous vaginal discharge and is confirmed to have Trichomonas infection. Treatment for her would include:

Question options:

Metronidazole 2 grams PO x 1 dose

Topical intravaginal metronidazole daily x 7 days

Intravaginal clindamycin daily x 7 days

Azithromycin 2 grams PO x 1 dose

Question 8 1 / 1 point

Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be:

Question options:

Appetite and concentration improve in the first 1 to 2 weeks.

Sleep should improve almost immediately upon starting citalopram.

Full response to the SSRI may take 2 to 4 months after he reaches the full therapeutic dose.

His dysphoric mood will improve in 1 to 2 weeks.

Question 9 1 / 1 point

Patients who have a poor metabolism phenotype will have:

Question options:

Slowed metabolism of a prodrug into an active drug, leading to accumulation of Prodrug

Accumulation of inactive metabolites of drugs

A need for increased dosages of medications

Increased elimination of an active drug

Question 10 1 / 1 point

The drug of choice for type 2 diabetics is metformin. Metformin:

Question options:

Decreases glycogenolysis by the liver

Increases the release of insulin from beta cells

Increases intestinal uptake of glucose

Prevents weight gain associated with hyperglycemia

Question 11 1 / 1 point

The first-line therapy for mild-persistent asthma is:

Question options:

High-dose montelukast

Theophylline

Low-dose inhaled corticosteroids

Long-acting beta-2-agonists

Question 12 1 / 1 point

All of the following statements about the Beer’s List are true except:

Question options:

It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available.

It is derived from the expert opinion of one geriatrician and is not evidence-based.

These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities.

These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration.

Question 13 1 / 1 point

Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because:

Question options:

It is a long-acting drug with potential for toxicity.

Nitrate tolerance can develop.

Orthostatic hypotension is a common adverse effect.

It must be taken with milk or food.

Question 14 1 / 1 point

True contraindications to diphtheria, tetanus, and acellular pertussis (DTaP or Tdap) vaccine include:

Question options:

Fever up to 104oF (40.5oC) after previous DTaP vaccine

Family history of seizures after DTaP vaccine

Adolescent pregnancy

Anaphylactic reaction with a previous dose

Question 15 1 / 1 point

Gender differences between men and women in pharmacokinetics include:

Question options:

More rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites

Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution

Increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations

Slower organ blood flow rates so drugs tend to take longer to be excreted

Question 16 1 / 1 point

Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include:

Question options:

Heart failure

Angina

Myocardial infarction

Dyslipidemia

Question 17 1 / 1 point

Developmental variation in renal function has what impact on prescribing for infants and children?

Question options:

Lower doses of renally excreted drugs may be prescribed to infants younger than age 6 months.

Higher doses of water soluble drugs may need to be prescribed because of increased renal excretion.

Renal excretion rates have no impact on prescribing.

Parents need to be instructed on whether drugs are renally excreted or not.

Question 18 1 / 1 point

When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as:

Question options:

Cost-minimization analysis

Cost-of-illness analysis

Cost-effectiveness analysis

Cost-benefit analysis

Question 19 1 / 1 point

Allison is an 18-year-old college student with type 1 diabetes. She is on NPH twice daily and Novolog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine?

Question options:

Delay eating the midday meal until after the swimming class.

Increase the morning dose of NPH insulin on days of the swimming class.

Adjust the morning insulin injection so that the peak occurs while swimming.

Check glucose level before, during, and after swimming.

Question 20 0 / 1 point

A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with:

Question options:

Methimazole

Propylthiouracil (PTU)

Radioactive iodine

Nothing, treatment is best delayed until after her pregnancy ends

Question 21 1 / 1 point

Which of the following is a primary benefit of the use of computerized provider order entry for patient medications?

Question options:

Reduces time that prescribing drugs takes

Eliminates the need to chart drugs prescribed

Decreases prescribing and transcription errors

Helps keep the number of drugs prescribed to a minimum

Question 22 1 / 1 point

Lisa is a healthy nonpregnant adult woman who recently had a urinary tract infection (UTI). She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be:

Question options:

Sixteen ounces per day of cranberry juice cocktail will prevent UTIs.

100% cranberry juice or cranberry juice extract may decrease UTIs in some patients.

There is no evidence that cranberry juice helps prevent UTIs.

Cranberry juice only works to prevent UTIs in children.

Question 23 1 / 1 point

Ginseng, which is taken to assist with memory, may potentiate:

Question options:

Aricept

Insulin

Digoxin

Propranolol

Question 24 1 / 1 point

While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are:

Question options:

Hemoglobin 14 g/dl or hematocrit 39%

Hemoglobin 11.5 g/dl or hematocrit 31%

Hemoglobin 13 g/dl or hematocrit 38%

Hemoglobin 17.5 g/dl or hematocrit 54%

Question 25 1 / 1 point

What is the role of calcium supplements when patients take bisphosphonates?

Question options:

They must be restricted to allow the medication to work.

They must be taken in sufficient amounts to provide foundational elements for bone growth.

They must be taken at the same time as the bisphosphonates.

They only work with bisphosphonates if daily intake is restricted.

Question 26 1 / 1 point

Clinical judgment in prescribing includes:

Question options:

Factoring in the cost to the patient of the medication prescribed

Always prescribing the newest medication available for the disease process

Handing out drug samples to poor patients

Prescribing all generic medications to cut costs

Question 27 1 / 1 point

The most cost-effective treatment for two or three impetigo lesions on the face is:

Question options:

Mupirocin ointment

Retapamulin (Altabax) ointment

Topical clindamycin solution

Oral amoxicillin/clavulanate (Augmentin)

Question 28 1 / 1 point

Medications are typically started for angina patients when:

Question options:

The first permanent EKG changes occur

The start of class I or II symptoms

The events trigger a trip to the emergency department

When troponin levels become altered

Question 29 0 / 1 point

Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:

Question options:

For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment

For pedal edema throughout therapy

Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm

For vision changes, such as red-green blindness, at least annually

Question 30 1 / 1 point

Alterations in drug metabolism among Asians may lead to:

Question options:

Slower metabolism of antidepressants, requiring lower doses

Faster metabolism of neuroleptics, requiring higher doses

Altered metabolism of omeprazole, requiring higher doses

Slower metabolism of alcohol, requiring higher doses

Question 31 1 / 1 point

The dosage of Vitamin B12 to initially treat pernicious anemia is:

Question options:

Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month

Vitamin B12 IM monthly

Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month

Oral cobalamin 1,000 mcg daily

Question 32 1 / 1 point

There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because:

Question options:

Renal excretion is similar in both classes of drugs.

When these drug classes are metabolized in the liver they both produce resistant enzymes.

Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms.

There is not an issue with cross-resistance between the penicillins and cephalosporins.

Question 33 1 / 1 point

The reason that two MMR vaccines at least a month apart are recommended is:

Question options:

The second dose of MMR “boosts” the immunity built from the first dose.

Two vaccines 1 month apart is the standard dosing for all live virus vaccines.

If the two MMR vaccine doses are given too close together there is a greater likelihood of severe localized reaction to the vaccine.

Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR.

Question 34 1 / 1 point

A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the:

Question options:

Concentration will produce therapeutic effects

Concentration will produce an adverse response

Time between doses must be shortened

Duration of action of the drug is too long

Question 35 1 / 1 point

Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)?

Question options:

It has a shorter half-life and withdrawal syndrome has a faster onset without taper.

It has the longest half-life and the withdrawal syndrome has a faster onset.

It is quasi-addictive in the dopaminergic reward system.

It is the most activating of SSRI medications and will cause the person to have sudden deep sadness.

Question 36 1 / 1 point

Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be:

Question options:

18 mg/day of iron supplementation

6 mg/kg per day of elemental iron

325 mg ferrous sulfate per day

325 mg ferrous sulfate tid

Question 37 1 / 1 point

Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes:

Question options:

Use the inhaled corticosteroid first, followed by the inhaled beta-agonists.

Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.

Increase fluid intake to 3 liters per day.

Avoid use of aspirin or ibuprofen while using inhaled medications.

Question 38 1 / 1 point

According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:

Question options:

The belief among African Americans that prayer is more powerful than drugs

Poor compliance on the part of the African American patient

The genetic predisposition for illness found among African Americans

Discrimination, cultural barriers, and lack of access to health care

Question 39 0 / 1 point

Precautions that should be taken when prescribing controlled substances include:

Question options:

Faxing the prescription for a Schedule II drug directly to the pharmacy

Using tamper-proof paper for all prescriptions written for controlled drugs

Keeping any pre-signed prescription pads in a locked drawer in the clinic

Using only numbers to indicate the amount of drug to be prescribed

Question 40 1 / 1 point

When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment?

Question options:

Total LDL

Fasting HDL

Coronary artery disease risk level

Fasting total cholesterol

Question 41 1 / 1 point

Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection?

Question options:

Juanita, a 28-year-old pregnant woman

Sally, a 16-year-old healthy adolescent

Jamie, a 24-year-old female

Suzie, a 26-year-old diabetic

Question 42 1 / 1 point

If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be:

Question options:

IV or IM gentamicin

IV or IM ceftriaxone

IV amoxicillin

IV ciprofloxacin

Question 43 1 / 1 point

Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to the patient who is starting varenicline include:

Question options:

The maximum time varenicline can be used is 12 weeks.

Nausea is a sign of varenicline toxicity and should be reported to the provider.

The starting regimen for varenicline is start taking 1 mg twice a day a week before the quit date.

Neuropsychiatric symptoms may occur.

Question 44 0 / 1 point

Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all?

Question options:

Betamethasone, an inhaled corticosteroid

Salmeterol, an inhaled long-acting beta-agonist

Albuterol, a short-acting beta-agonist

Montelukast, a leukotriene modifier

Question 45 1 / 1 point

Absolute contraindications that clinicians must consider when initiating estrogen therapy include:

Question options:

Undiagnosed dysfunctional uterine bleeding

Deep vein or arterial thromboemboli within the prior year

Endometriosis

Both a. and b.

All of the above

Question 46 1 / 1 point

Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions?

Question options:

Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action.

Additive antimuscarinic effects may occur with antihistamines.

Cholinergic blockers may decrease the sedative effects of hypnotics.

Cholinergic blockers are contraindicated with antipsychotics.

Question 47 1 / 1 point

Leonard is completing a 6-month regimen to treat tuberculosis (TB). Monitoring of a patient on TB therapy includes:

Question options:

Monthly sputum cultures

Monthly chest x-ray

Bronchoscopy every 3 months

All of the above

Question 48 1 / 1 point

The action of “gliptins” is different from other antidiabetic agents because they:

Question options:

Have a low risk for hypoglycemia

Are not associated with weight gain

Close ATP-dependent potassium channels in the beta cell

Act on the incretin system to indirectly increase insulin production

Question 49 1 / 1 point

Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true?

Question options:

Screening TSH has a wider range of normal values 0.02-5.0; therapeutic levels need to remain above 5.0.

Screening values are much narrower than the acceptable range used to keep a person stable on hormone replacement.

Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10.

Screening values are between 5 and 10, and therapeutic values are greater than 10.

Question 50 1 / 1 point

Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose:

Question options:

Rapidly achieves drug levels in the therapeutic range

Requires four- to five-half-lives to attain

Is influenced by renal function

Is directly related to the drug circulating to the target tissues

Question 51 1 / 1 point

Conjunctivitis in a child that is accompanied by acute otitis media is treated with:

Question options:

Sulfacetamide 10% ophthalmic solution (Bleph-10)

Bacitracin/polymyxin B (Polysporin) ophthalmic drops

Ciprofloxacin (Ciloxan) ophthalmic drops

High-dose oral amoxicillin

Question 52 1 / 1 point

To improve actual effectiveness of oral contraceptives women should be educated regarding:

Question options:

Use of a back-up method if they have vomiting or diarrhea during a pill packet

Doubling pills if they have diarrhea during the middle of a pill pack

The fact that they will have a normal menstrual cycle if they miss two pills

The fact that mid-cycle spotting is not normal and the provider should be contacted immediately

Question 53 1 / 1 point

An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is:

Question options:

Histamine2 receptor antagonists for 4 to 8 weeks

Proton pump inhibitor bid for 12 weeks until healing is complete

Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days

Proton pump inhibitor bid and levofloxacin for 14 days

Question 54 1 / 1 point

Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:

Question options:

Complete blood count

Blood glucose

C-reactive protein

BUN, creatinine, and creatinine clearance

Question 55 1 / 1 point

When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is:

Question options:

Immediate protection against pregnancy the first week of using the pill

No back-up method is needed when starting

Menses occur during the week

They can start the pill on the Sunday after the office visit

Question 56 1 / 1 point

Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?

Question options:

Increased volume of distribution

Decreased lipid solubility

Decreased plasma proteins

Increased muscle-to-fat ratio

Question 57 1 / 1 point

Rose is a 3-year-old patient with an upper respiratory infection (URI). Treatment for her URI would include:

Question options:

Amoxicillin

Diphenhydramine

Pseudoephedrine

Nasal saline spray

Question 58 1 / 1 point

Instructions for the use of nicotine gum include:

Question options:

Chew the gum quickly to get a peak effect.

The gum should be “parked” in the buccal space between chewing.

Acidic drinks such as coffee help with the absorption of the nicotine.

The highest abstinence rates occur if the patient chews the gum when he or she is having cravings.

Question 59 0 / 1 point

Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for:

Question options:

Urinary retention

Cardiac output

Peripheral edema

Skin rash

Question 60 0 / 1 point

Vicky, age 56 years, comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine. What is the best care for her?

Question options:

Switch her to sumatriptan (Imitrex) to treat her migraines.

Assess how often she is using Fiorinal and refill her medication.

Switch her to a beta blocker such as propranolol to prevent her migraine.

Request she return to the original prescriber of Fiorinal as you do not prescribe butalbital for migraines.

Question 61 1 / 1 point

Drugs that have a significant first-pass effect:

Question options:

Must be given by the enteral (oral) route only

Bypass the hepatic circulation

Are rapidly metabolized by the liver and may have little if any desired action

Are converted by the liver to more active and fat-soluble forms

Question 62 1 / 1 point

First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:

Question options:

OTC topical azole (clotrimazole, miconazole)

Oral terbinafine

Oral griseofulvin microsize

Nystatin cream or ointment

Question 63 1 / 1 point

A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women?

Question options:

Body temperature varies between men and women.

Muscle mass is greater in women.

Percentage of fat differs between genders.

Proven subjective factors exist between the genders.

Question 64 1 / 1 point

Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs?

Question options:

All opiates are scheduled drugs which require a DEA license to prescribe.

Opiates stimulate only mu receptors for the control of pain.

Most of the adverse effects of opiates are related to mu receptor stimulation.

Naloxone is an antagonist to opiates.

Question 65 1 / 1 point

A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response?

Question options:

Swelling of the tongue or hoarseness are the most common symptoms.

It appears to be related to the decrease in aldosterone production.

Presence of a dry, hacky cough indicates a high risk for this adverse response.

Because it takes time to build up a blood level, it occurs after being on the drug for about 1 week.

Question 66 1 / 1 point

The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include:

Question options:

Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program and in their APRN program.

Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care.

APRNs are less likely to prescribe narcotics and other controlled substances.

APRNs are able to prescribe independently in all states, whereas a physician’s assistant needs to have a physician supervising their practice.

Question 67 1 / 1 point

Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes:

Question options:

Throwing away eye makeup and purchasing new

Redness and intense burning is normal with ophthalmic antibiotics

When applying eye ointment, set the tip of the tube on the lower lid and squeeze in inch

Use a cotton swab to apply ointment, spreading the ointment all over the lid and in the conjunctival sac

Question 68 1 / 1 point

When determining drug treatment the NP prescriber should:

Question options:

Always use evidence-based guidelines

Individualize the drug choice for the specific patient

Rely on his or her experience when prescribing for complex patients

Use the newest drug on the market for the condition being treated

Question 69 1 / 1 point

Class I recommendations for stage A heart failure include:

Question options:

Aerobic exercise within tolerance levels to prevent the development of heart failure

Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention

Beta blockers for all patients regardless of cardiac history

Treatment of thyroid disorders, especially if they are associated with Tachyarrhythmias

Question 70 1 / 1 point

Male patients who should not be prescribed phosphodiesterase type 5 (PDE-5) inhibitors include:

Question options:

Diabetics

Those who have had an acute myocardial infarction in the past 6 months

Patients who are deaf

Patients under age 60 years of age

Question 71 1 / 1 point

The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be:

Question options:

Ciprofloxacin

Azithromycin

Amoxicillin

Doxycycline

Question 72 1 / 1 point

If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treating at home with OTC ranitidine daily, the appropriate treatment would be:

Question options:

Prokinetic (metoclopramide) for 4 to 8 weeks

Proton pump inhibitor (omeprazole) for 12 weeks

Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks

Cytoprotective drug (misoprostol) for 2 weeks

Question 73 1 / 1 point

Patients who are prescribed exogenous androgens need to be warned that decreased libido:

Question options:

Is an unusual side effect of androgens and should be reported to the provider

Is treated with increased doses of androgens, so the patient should let the provider know if he is having problems

May be a sign of early prostate cancer and he should make an appointment for a prostate screening exam

May occur with androgen therapy

Question 74 1 / 1 point

Which diuretic agents typically do not need potassium supplementation?

Question options:

The loop diuretics

The thiazide diuretics

The aldosterone inhibitors

They all need supplementation

Question 75 0 / 1 point

Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by:

Question options:

Increasing heart rate to improve cardiac output

Reducing vascular smooth muscle tone

Increasing aldosterone-mediated volume activity

Reducing aqueous humor production

Question 76 1 / 1 point

Patient education regarding taking iron replacements includes:

Question options:

Doubling the dose if they miss a dose to maintain therapeutic levels

Taking the iron with milk or crackers if it upsets their stomach

Iron is best taken on an empty stomach with juice

Antacids such as Tums may help the upset stomach caused by iron therapy

Question 77 1 / 1 point

Patient education for a patient who is prescribed antibiotics for sinusitis includes:

Question options:

Use of nasal saline washes

Use of inhaled corticosteroids

Avoiding the use of ibuprofen while ill

Use of laxatives to treat constipation

Question 78 1 / 1 point

Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for:

Question options:

High vitamin D levels

Hyperkalemia

Hypercalcemia

Hyperuricemia

Question 79 1 / 1 point

Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be:

Question options:

Increase her dose

Assess for suicidal ideation

Discontinue the medication immediately

Decrease her dose to half then slowly titrate up the dose

Question 80 1 / 1 point

Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that:

Question options:

Has a short half-life so that missing one dose has limited effect

Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down

Has a tolerability profile with fewer of the adverse effects that are considered “irritating,” such as nausea and dizziness

Must be taken no more than twice a day

Question 81 1 / 1 point

Which the following persons should not have a statin medication ordered?

Question options:

Someone with 3 first- or second-degree family members with history of muscle issues when started on statins

Someone with high lipids, but low BMI

Premenopausal woman with recent history of hysterectomy

Prediabetic male with known metabolic syndrome

Question 82 1 / 1 point

The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act:

Question options:

Requires all providers to screen their patients for methamphetamine use

Restricts the prescribing of amphetamines to U.S. citizens

Requires a prescription be written for all methamphetamine precursors in all states

Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales

Question 83 0 / 1 point

Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes:

Question options:

Platelet count

BUN and creatinine

White blood cell count

AST, ALT, alkaline phosphatase, and bilirubin

Question 84 0 / 1 point

Which of the following holds true for the pharmacokinetics of women?

Question options:

Gastric emptying is faster than that of men.

Organ blood flow is the same as that of men.

Evidence is strong concerning renal differences in elimination.

Medications that involve binding globulins are impacted by estrogen levels.

Question 85 0 / 1 point

Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?

Question options:

Add an H2 blocker such as ranitidine to his therapy.

Discontinue the aspirin and switch him to Vicodin for the pain.

Decrease the aspirin dose to one tablet daily.

Have Henry take an antacid 15 minutes before taking the aspirin each day.

Question 86 1 / 1 point

When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient:

Question options:

Not to take their regularly prescribed medications while on these antibiotics

Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption

Not to take antacids while on these medications, as the antacid decreases absorption

That there are no drug interactions with these antibiotics

Question 87 1 / 1 point

A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:

Question options:

Ensure the patient will not have increased adverse drug reactions to the tamoxifen

Identify potential drug-drug interactions that may occur with tamoxifen

Reduce the likelihood of therapeutic failure with tamoxifen treatment

Identify poor metabolizers of tamoxifen

Question 88 1 / 1 point

IV forms of bisphosphonates are used for all the following except:

Question options:

Severe gastric irritation with oral forms

Known cancer mets into the bone

Persons with advancing renal dysfunction

Progression of bone loss on oral formulations

Question 89 1 / 1 point

The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class:

Question options:

I

II

III

IV

Question 90 1 / 1 point

ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy?

Question options:

Diuretics

ARBs

Beta blockers

Nitrates

Question 91 1 / 1 point

Pharmacoeconomics is:

Question options:

The study of the part of the U.S. economy devoted to drug use

The study of the impact of prescription drug costs on the overall economy

The analysis of the costs and consequences of any health-care-related treatment or service

The analysis of the clinical efficacy of the drug

Question 92 1 / 1 point

Goals when treating tuberculosis include:

Question options:

Completion of recommended therapy

Negative purified protein derivative at the end of therapy

Completely normal chest x-ray

All of the above

Question 93 1 / 1 point

Elena Vasquez’s primary language is Spanish, and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed?

Question options:

Use correct medical terminology because Spanish has a Latin base.

Use a family member who speaks more English to act as an interpreter.

Use a professional interpreter or a reliable staff member who can act as an interpreter.

Use careful, detailed explanations.

Question 94 1 / 1 point

Which of the following statements is true about acute pain?

Question options:

Somatic pain comes from body surfaces and is only sharp and well-localized.

Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates.

Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site.

Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area.

Question 95 1 / 1 point

The role of the NP in the use of herbal medication is to:

Question options:

Maintain competence in the prescribing of common herbal remedies

Recommend common over-the-counter herbs to patients

Educate patients and guide them to appropriate sources of care

Encourage patients to not use herbal therapy due to the documented dangers

Question 96 1 / 1 point

Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to:

Question options:

Search for information using the most common search engines

Serve as content experts in developing, implementing, and evaluating information Systems

Write programs to assure the integrity of health information

Use information technology to prescribe drugs

Question 97 0 / 1 point

Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain.What are the symptoms of aspirin toxicity for which she would  need to be evaluated?

Question options:

Tinnitus

Diarrhea

Hearing loss

Photosensitivity

Question 98 1 / 1 point

Nurse practitioner prescriptive authority is regulated by:

Question options:

The National Council of State Boards of Nursing

The U.S. Drug Enforcement Administration

The State Board of Nursing for each state

The State Board of Pharmacy

Question 99 1 / 1 point

An Investigational New Drug is filed with the U.S. Food and Drug Administration:

Question options:

When the manufacturer has completed phase III trials

When a new drug is discovered

Prior to animal testing of any new drug entity

Prior to human testing of any new drug entity

Question 100 1 / 1 point

Preventative therapy for cluster headaches includes:

Question options:

Massage or relaxation therapy

Ergotamine nightly before bed

Intranasal lidocaine four times a day during “clusters” of headaches

Propranolol (Inderal) daily