Read Chapter 12

1. What are three questions you should ask yourself when you begin your job search?

2. What are the most common mistakes people make in preparing their résumés?

3. What should you know about your prospective employer before the job interview?

4. What should the interviewee try to achieve during a job interview? What should you look for? What red flags should you watch for?

5. What can you do in advance to prepare for the changes during the first year of employment?

6. Create your own SWOT analysis. How would you respond to your personal strengths and weaknesses if you were a prospective employer? How can you enhance your strengths and improve in areas of weakness?

7. Draw a career path for yourself, beginning with the present year and extending to the age of retirement. Be sure to include any “twists and turns” of the path you expect to experience along the way and any barriers you expect to encounter. How will you handle these experiences?

Do an online nationwide search for information about current job prospects in nursing.Compare opportunities in various regions of the country. Why do you think these opportunities are the same or different?

5. Develop a list of questions that you should ask a potential employer. What “homework” will you need to do to prepare for an interview? 

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Nurses can use group power strategies such as networking, connecting, and collaborating to achieve professional goals and contribute to the welfare of patients as well as to the health of the population (Huber, 2014). Personal affiliations and networking are essential for multiple reasons, as it allows for the idea and strategy sharing. I think of networking as a way of managing own life. I frequently ask the co-workers for advice on what has worked for them in their units and how they have found success; this networking has been so helpful in the career. Another big part of personal affiliations and networking is own involvement in professional organizations. This current information and idea sharing can have a significant impact on and manager. I joined the ENA (Emergency Nurse Association) when I was still a bedside nurse and have continued my membership into my career as a director; I find that it is an excellent resource for idea sharing. There is so much evidence-based practice that is available through the ENA, and found that extremely helpful and saw it continue to benefit in the career in the future. 

Another professional organization that I became a member is Association of California nursing Leaders, ACNL. Through them, went to the conference of nursing students, where issues essential to nursing students such as LGBT and gender rights and allocation of help to drug users. Living in Los Angeles area for a while, I gave speeches there for the national nursing community on the importance of the issues. Even after many speeches and voting, the audience showed divisions on the issue. 

Leadership networks provide information, networking, and professional development for nursing school faculty and staff. The Networks bring peer professionals together to share best practices and success stories, sharpen leadership skills, and take full advantage of multiple resources (American Association of Colleges of Nursing, 2014). Professionals who are engaged in a variety of functions within the nursing are in tune with networks across nursing. There has been a massive push in the workplace organization for nurses to get involved and enrich themselves as professionals.

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Personal affiliations and networking are important for nursing leaders because you never know who you will meet that you might share a benefiting relationship from. When I was new to my organization, I would go to benefits to not only network but give back to the community. I met people higher in the company who have liked my affect. Because of my good report with people in higher positions, I was able to grow in the organization’s community. Another situation where we have networked for the community’s benefit happens every year, the unit as a whole raises money in order to benefit the American Heart Association’s Heart Walk. We do a bake sale by the cafeteria in our hospital, we do a beef and beer at a local bar, and we raise money in other ways as well. It is always very beneficial to give back to the community and it also makes connections with others that you wouldn’t expect.

 

The case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

Ms. G., a 23-year-old diabetic, is admitted to the hospital with a cellulitis of her left lower leg. She has been applying heating pads to the leg for the last 48 hours, but the leg has become more painful and she has developed chilling.

Subjective Data

• Complains of pain and heaviness in her leg.
• States she cannot bear weight on her leg and has been in bed for 3 days.
• Lives alone and has not had anyone to help her with meals.

Objective Data

• Round, yellow-red, 2 cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainage
• Left leg red from knee to ankle
• Calf measurement on left 3 in > than right
• Temperature: 38.9 degrees C
• Height: 160 cm; Weight: 83.7 kg

Laboratory Results

• WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands
• Wound culture: Staphylococcus aureus

Critical Thinking Questions

1. What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
2. Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
3. What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.
4. What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

 

Question

Question 1

More than half of all cardiac arrhythmias involve the atria.

True

False

Question 2. 

What are the most common symptoms caused by tachyarrhythmias?

Sweating 

Thirst

Palpitations

Headaches

Question 3. 

For women with known CAD and diabetes, which is most appropriate to assess CAD risk?

ETT

Coronary bypass surgery

Coronary catheterization

ETT with imaging

Question 4. 

Of the following, which is the best answer when asked for an advantage of echocardiogram exercise testing over thallium stress testing?

Does not depend on operator experience

Costs are the same

Results are available more quickly

Doesn’t matter because there are no advantages

Question 5. 

Your patient has uncomplicated pyelonephritis. In deciding your recommended treatment, you consider the most common pathogenic reason for this diagnosis. What pathogen accounts for the majority of pyelonephritis?

E. Coli

Gardnerella Vaginalis

Mycoplasma Hominis

Chlamydia

Question 6. 

What purpose does the principle of fidelity serve in the provider/patient relationship?

Ensures that providers honor their commitments to the patient

Obligates the provider to a one-on-one relationship with the individual

Ensures that patients receive whatever they want

Maintains costs in the healthcare arena

Question 7. 

In CAD, after both systolic and diastolic dysfunction have occurred, the typical pattern of chest pain and related EKG changes occur. During an EKG, you should expect to see ST-segment and T-wave changes that are central to demonstration of ischemia occurring relatively late in the ischemic cascade. Is this true or false?

True

False

Question 8. 

The leads on the ECG showing ischemic changes during or immediately after an ETT can correlate roughly to the culprit artery or arteries with significant CAD. Is this true or false?

True

False

Question 9. 

Skin cancer is the most common malignant neoplasm in males in the US. What is the second leading cause of cancer deaths in men greater than 50 years of age?

Prostate cancer

Lung cancer

Lymphoma

Lupus

Question 10. 

What ECG changes can reduce the specificity of the ETT?

Exercise induced bundle branch blocks

Paced rhythm and resting bundle branch block

Paced rhythm and exercise induced bundle branch blocks

Low voltage up sloping of the ST-segment

Question 11. 

You have confirmed that your patient does indeed have an abdominal aortic aneurysm. In teaching your patient about symptoms to report immediately to the vascular surgeon, you instruct the patient to report which of the following?

Newly diagnosed diabetes

Back pain or flank pain

Visual disturbances

Headaches

Question 12. 

What is one of the common causes of a Saccular Abdominal Aneurysm?

Poor kidney functioning

Age

Drugs: illicit and prescribed

Trauma

Question 13. 

The diagnostic accuracy of stress testing is decreased among women compared to men for what reasons?

Women having thinner ventricular and septal muscles

Women usually have single vessel or non-obstructive disease

Women cannot exercise as vigorously as men

Women typically have multiple vessel disease

Question 14. 

Population disease management is a term used to describe:

High specificity disease states

Low specificity diseases states

Low prevalence specific diseases

High prevalence specific diseases

Question 15. 

You receive a report back on the suspected abdominal aortic aneurysm for your patient. It confirms your suspicion of AAA. The report describes the aneurysm as a symmetric weakness of the entire circumference of the aorta. You know that this form of aneurysm is referred to as what kind of aneurysm?

Thoracic aneurysm

Budging sac aneurysm

Saccular aneurysm

Fusiform aneurysm

Question 16. 

Your practice partner just ordered an exercise echocardiography 2DE for a patient with suspected cardiovascular risk. This patient has known resting wall motion abnormalities.Why would this not be the best test to assess this patient’s cardiac risk?

Sensitivity is increased

Sensitivity is decreased

Specificity is increased

Specificity is decreased

Question 17. 

Your 60-year old male patient arrives for his appointment. He complains of general malaise and fever over the past several days with low back pain. He also states that he is getting up at night more often to urinate and never feels his bladder is completely empty.What differential diagnosis should you consider in this patient?

Acute viral prostatitis

Stomach virus

Acute bacterial prostatitis

BPH only

Question 18. 

We all know that collaboration is integral to becoming a successful nurse practitioner. Among collaborations, however, only one can be considered as the most important. While each example below is important, which is the most important collaboration? The one that occurs:

Between the nurse practitioner and their physician mentor

Between two healthcare providers about a single patient

Between the patient and their family

Between the patient and the nurse practitioner

Question 19. 

The sensitivity of a routine ETT is effort dependent. What physiological changes occur during effort in the routine ETT?

Rapid heart rates and coronary artery narrowing

Decrease in coronary blood flow

Decreased heart rate and increased systolic blood pressure

Increased coronary flow and increased systolic blood pressure

Question 20. 

A 47-year old female with general complaints of fatigue and shortness of breath shows up in your clinic as a referral from another nurse practitioner. Several blood tests and chest x-rays have been completed without any diagnosis or outstanding abnormalities.You decide to order an ETT despite the fact that the recent ECG does not show any abnormalities. From the answers below, which would be the best answer to support your decision?

You are out of other options

CAD in women is under diagnosed

To please the patient

Women present with the same pattern of CAD as do males

Question 21. 

Your patient underwent an exercise stress test for CAD. There is significant elevation of the ST-segment.What do you need to know about these changes to manage your patient’s care?

: This patient needs to see someone more experienced in treatment of CAD

These changes are predictive of myocardial infarction

These changes have minimal predictive value for CAD

These changes predict dire outcomes

Question 22. 

When there is a consequential loss of structural integrity of the abdominal aorta, the resulting issue is what condition?

Bloated stomach

Kidney failure

Bleeding ulcers

Abdominal aortic aneurysm

Question 23. 

You see a 60-year old African American male in your clinic with a recent diagnosis of hypertension. He asks you what he should restrict in his diet, and is particularly interested in limiting his sodium intake. What amount of sodium intake would you recommend on a daily basis for this patient?

1.5 g/day

No added table salt

3.0 g/day

2.3 g/day

Question 24. 

Why would inability to exercise reduce the specificity of the routine ETT?

Produces QRS changes that cannot be interpreted

Produces persistent ST-segmental changes and T-wave abnormalities

Causes ST-segment changes and P-wave abnormalities

Will not produce any changes in ECG

Question 25. 

By standard criteria, how is a positive stress test defined?

Development of a horizontal or down sloping ST-segment depression of 1mm

Down sloping of the ST-segment at the J point of the QRS

Development of a horizontal or down sloping ST-segment depression of 10mm

Upward sloping ST-segment measured at the J point of the QRS

Question 26. 

What are the two types of bradycardia recognized by the American Heart Association?

Relative and absolute

Absolute and pending

Refractory and non-refractory

Relative and dynamic

Question 27. 

You see a 75-year old female in your clinic today complaining of urinary incontinence. She is otherwise healthy based upon her last visit. She states that her mother told her this would happen someday because it happens to every woman at some age. What would you tell this patient?

This happens to all women as they age

No need to worry. This is normal. Your mother was correct.

This is not an expected condition related to aging.

This happens to men as well and most women before your age.

Question 28.

What do you know regarding ischemia that is confined to only the posterior and or lateral segments of the left ventricle?

ETT cannot be used for detection

Difficult to detect by ETT

Requires both for detection of changes by ETT

Easier to detect by ETT

Question 29. 

What three conditions definitely alter the results of echocardiography in determining CAD?

Obesity, rapid heart rate and lung disease

Diabetes, kidney disease and tooth decay

Obesity, slow heart rates and hypertension

Previous MI, hypotension and diabetes

Question 30. 

Specifically, when is an ETT considered to be negative?

Patient has ST-segmental changes with down sloping of greater than 1 mm at 50% of age-predicted maximum heart rate

Patient exercises to 85% of age predicted maximum heart rate without evidence of induced ischemia

Patient exercises to 20% maximum age-predicted heart rate without induced ischemia

Patient exercises until tired without evidence of induced ischemia

Question 31. 

All patients, even is asymptomatic, require risk stratification according to the Farmingham risk score. At present, ACC/AHA guidelines, however, do not normally support stress tests for asymptomatic patients without addiitonal justification. From the list below, what could be used to justify a ETT in an asymptomatic patient?

A smoker of 3 weeks

A member of congress

Sedentary and wishes to begin aggressive exercise

Developmentally challenged

Question 32. 

BPH is not a risk factor for Prostate cancer. Is this statement true or false?

True

Question 33. 

Spread of genital herpes only occurs during the time period with active lesions. Is this statement true or false?

True

False(not confirm)

Question 34. 

Abdominal aortic aneurysms are often asymptomatic. What percent of AAA’s are discovered in asymptomatic patients?

40%

20%

10%

75%

Question 35. 

Improvements in the delivery and management of healthcare are necessary if we are to improve the overall health of this nation’s population. Which of the following are identified in your readings as strategic in the movement to improve the healthcare system?

President and Congress

Population management and healthcare practice

Socialized medicine and governmental controls

Monetary savings and limited disruption in healthcare delivery

Question 36. 

What are the two main types of heart failure?

Systolic and diastolic

Hopeless and severe

Left sided and main

End diastolic and pressure related

Question 37. 

The majority of all strokes are non-ischemic. Is this statement true or false?

True

False

Question 38. 

When a murmur is first heard, it is important to determine if it is due to a pathological condition or benign. For an experienced practitioner, it is always easy to determine the cause of a murmur merely by listening to the sound. Is this statement true or false?

True

False

Question 39. 

Maintenance of an Isometric ST-segment during exercise is the response of?

A normal heart

Hypo profusion

An abnormal heart

CAD

Question 40. 

The goal of self-management is to specifically do what?

Engage patients in their own care

Engage insurance providers in patient care

Engage providers in patient care

Engage government in greater involvement in patient care

Question 41. 

Your 56-year old patient presents with bradycardia with a rate of 55 and first degree AV block. The patient is hemodynamically stable and is not experiencing any syncope or chest pain. History includes previous myocardial infarction. Home medications include beta blockers, daily aspirin. Lab work is non-significant for electrolyte imbalance. You decided to treat this patient for the arrhythmia to prevent future destabilization. From the choices below, which might be the appropriate first measure to consider?

Add digitalis to control the heart rate

Consult cardiologist immediately for guidance

Discontinue Beta Blocker and replace with another therapy if necessary

Atropine injections

Question 42. 

Your patient is morbidly obese and cannot sit on a bicycle or walk a treadmill. She also has marked and severe emphysema. You need to make an assessment of the risk of significant CAD and your patient’s family says that their relative had their diagnosis based on an ultrasound echocardiography. What facts would influence your decision regarding the family request for echo assessment?

Sensitivity would be increased because of lung disease

Specificity would be increased because of obesity

Sensitivity would be reduced because of obesity and lung disease

Specificity would be reduced because of obesity and lung disease

Question 43. 

You are in the clinic with your mentor observing the Echocardiogram exercise test of a 45-year old male that has been experiencing slight chest pressure almost daily during exercise.While observing your patient, your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of the ventricular wall. From your time in the clinic, you know that this test will be considered to be what type of result?

Negative

Impossible

Positive

Non-readable

Question 44. 

Your patient is newly diagnosed with persistent Atria Fibrillation. You consider electrocardioversion. Before undergoing this procedure you should order the following examination to assess thrombus risk.

X-Ray of chest

Tranesophageal echocardiography

Ultrasound of chest

CT Scan

Question 45. 

Tachyarrhythmias cause a drop in commonly blood pressure, cardiac output, syncope, shortness of breath, and chest pain. What phenomenon most often occurs during these arrhythmias to cause these symptoms?

Shortened diastole

Lengthened diastole

Lengthened systole

Shortened systole

Question 46. 

At what age is atria fibrillation most common?

In childhood

60 years or older

30 years

45 years

Question 47. 

Automaticity is a property common to all cardiac cells. Is this statement true or false?

True

False

Question 48. 

Your patient has a maximum age-predicted heart rate of 180. During the exercise he reaches a heart rate of 140 and then states he can no longer exercise. You see evidence of ischemic changes on the ECG. This would be predictive of what condition?

Stroke

Significant CAD

Impending death

Low risk of CAD

Question 49. 

You tell a patient that he has a murmur. He says he has been told this before, but wonders what causes the unique sounds of a murmur. Which of the following would be your best option?

Turbulent flow of blood

High pressures caused from HTN

There is no reason, it just happens

Almost always from a sclerotic valve

Question 50. 

What is the treatment of choice for uncomplicated community-acquired cystitis?

TMP-SMZ

Any antibiotic will treat this diagnosis

Amoxicillin

Penicillin

Question 51. 

Any patient presenting with symptomatic bradycardia should be referred 

to a cardiologist for management. Is this statement true or false?

True

False

Question 52. 

Encouragement of patients to take effective actions in their own healthcare refers to the concept of:

Self-management support

Interprofessional support

Physician or provider-driven care

Family care givers

Question 53. 

You are considering adding an adjunctive form of testing to detect wall motion abnormalities during the ETT.You select Echocardiography as the added testing. You choose this test because you know that echocardiography does what when added to a standard ETT?

Enhances sensitivity and specificity of CAD detection

Enhances sensitivity while reducing specificity of CAD detection

Enhances specificity while not changing sensitivity of detection for CAD

You like pretty pictures of wall motion

Question 54. 

Medicaid is mandated to be provided by each state through federal codes. Each state must offer Medicaid exactly as the federal government prescribes. True or false?

True

False

Question 55. 

What sexually transmitted disease is most widespread in the USA today?

Chlamydia

Gonorrhea

Syphilis

HIV/AIDS

Question 56. 

Your preceptor decides to add Doppler Flow studies to the echocardiogram exercise test for a patient with a recent history of a holistic murmur best auscultated at the left steral boarder. The patient has no history of cardiac surgeries. He asks you what might be the main advantages of adding Doppler Flow for this particular patient. You know from your readings that there are several reasons to add Doppler Flow and below are listed more than one correct reason. Your best response for this specific case, however, would be that Doppler Flow studies would be of what additive value during the echocardiogram study?

Detect and evaluate blood shunting from a septal defect

No advantage is seen for this patient

Gives better screen shots of wall abnormalities

Provides assessment of prosthetic valve function

Question 57. 

Sexual partners of a patient with a diagnosed STI should always be examined and treated. Is this statement true or false?

True

False

Question 58. 

Your patient presents with tachycardia. The QRS is measured at 0.10 seconds. Which of the following tachycardias would be an appropriate conclusion based on this information alone?

Ventricular tachycardias

Premature junctional contractions

Atria fibrillation

Ventricular fibrillation

Question 59. 

A 65-year old white male arrives in your clinic with general complaints of slight abdominal discomfort. He has a known history of smoking two packs per day for 40 years and hypertension. He also has COPD and has been treated numerous times with oral steroids. You consider several optional diagnoses. Of the ones listed below, which should be included as a potential top suspect in your choice of diagnosis?

Chronic bowel obstruction

Meglacolon

Appendicitis

Abdominal aortic aneurysm

Question 60. 

What are the most common mechanisms to produce cardiac arrhythmias?

Decreased automaticity, triggered activity or reentry

Reentry, electrical dysfunction or activity

Stress, hard work or swimming

Enhanced automaticity, triggered activity or reentry