Archive for month: May, 2019

QUESTION 1: Healthcare Delivery and Evidenced –Based Nursing Practice

The registered nurse working in the cardiac care clinic is tasked with implementing quality improvement measures. To educate the clinic staff, the nurse plans an in-service program to introduce concepts of quality improvement and evidence-based practice. Additionally, the role of the case manager will be included in the presentation. The nurse plans on using care of the patient with Congestive Heart Failure as a template, and prepares sample clinical pathways, care maps, and multidisciplinary action plans. (Learning Objective 3)

a. Describe how clinical pathways are used to coordinate care of caseloads of patients.

b. What is the role of the case manager in evaluating a patient’s progress?

c. What are examples of evidence-based practice tools used for planning patient care?

QUESTION 2: Community-Based Nursing Practice

Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital following an admission for COPD. She has a past medical history of a colon resection related to acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her care at home, home care visits were ordered. (Learning Objective 5).

a. What would be involved in setting up the first home care visit?

b. Describe the nursing assessments and management that would occur during the visit.

QUESTION 3: Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing Process

1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort. (Learning Objective 4)

What ethical dilemma exists?

Who are the stakeholders and what gains or losses do each have?

What strategies should the hospice nurse take to resolve the ethical dilemma?

QUESTION 4:

Chapter 4, Health Education and Health Promotion

he community health nurse is planning a health promotion workshop for a high school PTSO (Parent-Teacher-Student Organization). The choice of topics was suggested by the high school’s registered nurse who has observed a gradual increase in student obesity. The two nurses have collaborated to develop this workshop to provide parents, students, and teachers with information about the importance of health promotion. (Learning Objectives 6, 8, and 9)

a. Describe the importance of a focus on health promotion.

b. According to the health promotion model developed by Becker (1993), what four variables influence the selection and use of health promotion behaviors?

c. Describe four components of health promotion.

QUESTION 5: Chapter 5, Adult Health and Nutritional Assessment

The registered nurse prepares to conduct a nutritional assessment on Mrs. Varner, a 52-year-old Caucasian female who describes herself as “overweight most of my adult life.” The client states that her health is good. She works part time as a receptionist and volunteers about 10 hours per week in her church. The nurse obtains Mrs. Varner’s height as 64 inches and her weight as 165 pounds. (Learning Objective 8)

a. What is the rationale for computing body mass index? What is Mrs. Varner’s BMI?

b. Calculate her ideal body weight. What is your assessment of her BMI and weight?

c. Based on Mrs. Varner’s BMI and weight, the nurse measures her waist circumference. Describe the proper procedure for this assessment.

d. Mrs. Varner’s waist circumference is 38 inches. What is your assessment?

e. What laboratory values would the nurse review to evaluate Mrs. Varner’s protein levels?

QUESTION 6: Chapter 6, Individual and Family Homeostasis, Stress, and Adaptation

Mary Turner stepped on a nail 5 days ago and sustained a puncture about 1 inch deep. She immediately cleaned the area with soap and water and hydrogen peroxide, and applied triple antibiotic ointment to the site. Today she comes to the clinic with complaints of increased pain and swelling in her foot. On assessment, the nurse notes that the puncture site is red and edematous, and has a moderate amount of yellowish drainage. (Learning Objective 9)

a. Describe the sequence of events that caused the local inflammation seen in Mary’s foot.

b. What is the role of histamine and kinins in the inflammatory process?

c. Which of the five cardinal signs of inflammation does Mary exhibit?

d. Because Mary’s injury occurred 5 days ago, the nurse should assess for what systemic effects?

QUESTION 7:

Chapter 7, Overview of Transcultural Nursing

The nurse manager of an ambulatory care clinic has noted an increased number of visits by patients from different countries and cultures, including patients from Mexico and other Latin American countries. Concerned about meeting the needs of this culturally diverse population, the nurse manager convenes a staff meeting to discuss this change in patient demographics, and to query the staff about any learning needs they have related to the care of these patients. (Learning Objective 3)

a. What strategy to avoid stereotyping clients from other cultures should the nurse include in this meeting?

b. Identify culturally sensitive issues to be discussed in the staff meeting.

c. One technician on the staff complains that some patients never make eye contact, and this makes it difficult for him to complete his work. How should the nurse respond?

QUESTION 8: Chapter 8, Overview of Genetics and Genomics in Nursing

Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition. (Learning Objective 2)

a. Describe the pattern of autosomal dominant inheritance.

b. Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond?

c. Explain the phenomenon of penetrance observed in autosomal dominant inheritance.

QUESTION 9: Chapter 9, Chronic Illness and Disability

Mr. Edwards is 20-year-old male patient who is admitted for treatment of recurring pyelonephritis (kidney infection) and surgical treatment of a urinary stricture, which has decreased the urinary stream. Mr. Edwards has paraplegia; he is paralyzed from the waist down secondary to an automobile accident when he was 16. He came by ambulance to the hospital, leaving his wheelchair and wheelchair pressure-relieving cushion at home. According to the nursing history, the patient is a nonsmoker and he does not drink alcohol or take any illegal drugs. (Learning Objective 5)

a. What nursing considerations should be made for Mr. Edwards related to his disability?

b. What health promotion and prevention education does Mr. Edwards need?

QUESTION 10: Chapter 10, Principles and Practices of Rehabilitation

You are assigned to care for David Ramsey, a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord, but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility.

(Learning Objective 4)

a. What assessments are indicated based on this nursing diagnosis?

b. List other major nursing diagnoses based on David’s clinical presentation.

QUESTION 11:

Chapter 11, Health Care of the Older Adult

The nurse working at the senior center notices Mrs. Jones, a 78-year-old, crying. The nurse approaches Mrs. Jones and asks if she needs help. Mrs. Jones states “I am so embarrassed. I had another accident and my pants are all wet. It’s like I’m a baby. I never should have come to the senior center.” (Learning Objectives 3 and 4)

a. What factors may be contributing to the urinary incontinence?

b. How should the nurse respond to Mrs. Jones?

QUESTION 12:

Chapter 12, Pain Management

Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). As the nurse assumes care of Mr. Rogers, he is alert and fully oriented, and states that his current pain is 2 on a 1-to-10 scale. His vital signs are 37.8 – 92 – 12, 138/82. (Learning Objective 6)

What are benefits of epidural versus systemic administration of opioids?

b. The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments?

c. The nurse monitors Mr. Rogers for what other complications of epidural analgesia?

d. Mr. Rogers complains of a severe headache. What should the nurse do?

e. Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation?

QUESTION 13:

Chapter 13, Fluid and Electrolytes: Balance and Disturbance

Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. (Learning Objective 4)

a. What are possible causes of a low potassium level?

b. What action should the nurse take in relation to the serum potassium level?

c. What clinical manifestations might the nurse assess in Mrs. Dean?

Question 14:

Chapter 14, Shock and Multiple Organ Dysfunction Syndrome

Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7)

a. What predisposed the patient to develop septic shock?

b. What potential findings would suggest that the patient’s septic shock is worsening from the point of admission?

c. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication?

d. Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient?

QUESTION 15:

Chapter 15, Oncology: Nursing Management in Cancer Care

The oncology clinical nurse specialist (CNS) is asked to develop a staff development program for registered nurses who will be administering chemotherapeutic agents. Because the nurses will be administering a variety of chemotherapeutic drugs to oncology patients, the CNS plans on presenting an overview of agents, classifications, and special precautions related to the safe handling and administration of these drugs. (Learning Objectives 6 and 8)

a. What does the CNS describe as the goals of chemotherapy?

b. How should the CNS respond to the following question: “Why do patients require rounds of chemotherapeutic drugs, including different drugs and varying intervals?”

c. In teaching about the administration of chemotherapeutic agents, what signs of extravasation should the nurse include?

d. What clinical manifestations of myelosuppression, secondary to chemotherapy administration, should the CNS include in this program?

QUESTION 16:

Chapter 16, End-of-Life Care

Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort. (Learning Objective 9)

a. What nursing measures should the nurse use to manage the patient’s dyspnea?

b. The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses?

QUESTION 17:

Chapter 17, Preoperative Nursing Management

The nurse in a gynecology clinic is completing preoperative teaching for a patient scheduled for an abdominal hysterectomy next week. The patient states that she is currently taking 325 mg of aspirin daily for chronic joint pain, along with a multivitamin. The patient has type 2 diabetes; she closely monitors her blood glucose levels. Currently, she is taking an oral hypoglycemic agent. The nurse advises her to ask the anesthesiologist whether she should take this medication the morning of surgery. (Learning Objectives 2 and 4)

a. The nurse instructs the patient to stop taking the aspirin. What is the rationale for this action?

b. Why is it important to assess the patient for use of herbal products prior to surgery?

c. The patient asks how surgery could affect her blood glucose; how should the nurse respond?

QUESTION 18: Chapter 18, Intraoperative Nursing Management

Pearl Richards, 69 years of age, is a female patient who is in the operating room for a repair of an abdominal aortic aneurysm. The patient has a history of hypertension controlled with medications, osteoporosis, chronic obstructive pulmonary disease, and has smoked two packs of cigarettes per day for 40 years. (Learning Objectives 2, 6, and 9)

a. What nursing interventions are instituted to reduce the surgical risk factors related to the patient’s age?

b. Explain the role of the nurse in providing patient safety measures during the intraoperative period.

QUESTION 19: Chapter 19, Postoperative Nursing Management

1. Rita Schmidt, 74 years of age, is a female patient who was admitted to the surgical unit after undergoing removal of a section of the colon for colorectal cancer. The patient does not have a colostomy. The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the staples are dry and intact. There is a Jackson-Pratt drain intact with minimal serous sanguineous drainage present. The patient has a Salem sump tube connected to low continuous wall suction that is draining a small amount of brown liquid. The patient has no bowel sounds. The Foley catheter has a small amount of dark amber-colored urine without sediments. The patient has sequential compression device (SCD) in place. The nurse performs an assessment and notes that the patient’s breath sounds are decreased bilaterally in the bases and the patient has inspiratory crackles. The patient’s cardiac assessment is within normal limits. The patient is receiving O2 at 2 L per nasal cannula with a pulse oximetry reading of 95%. The vital signs include: blood pressure, 100/50 mm Hg; heart rate 110 bpm; respiratory rate 16 breaths/min; and the patient is afebrile. The patient is confused as to place and time. (Learning Objectives 4 and 7)

a. Explain the assessment parameters used to provide clues to detect postoperative problems early and the interventions needed.

b. What gerontological postoperative considerations should the nurse make?

2. Mr. John Smith is admitted to the hospital for surgical incision and drainage (I&D) of an abscess on his right calf, which resulted from a farm machinery accident. The right calf has an area 3 cm × 2.5 cm, which is red, warm and hard to touch, and edematous. (Learning Objective 5)

a. Explain the wound healing process according to the phase of Mr. Smith’s wound?

b. The surgeon orders for wet-to-dry sterile saline dressing twice a day with iodoform gauze to the wound, covered with the wet-to-dry dressing. Explain how to perform this dressing change

Questions 1 – 9: Sample. (For help with these questions, refer to chapters: 9 & 12)

1. What sampling method or plan was used by the authors in this study?

a. Simple random sampling

b. Systematic sampling

c. Convenience sampling

d. Network sampling

2. According to Grove, Gray, and Burns (2015), what are the potential biases of this sampling method?

a. This is a strong probability sampling method with very little potential for bias

b. This method is used when an ordered list of all members of the population are available, and provides a random but not equal chance for inclusion in the study.

c. This method provides little opportunity to control for bias because subjects are included in the study merely because they happen to be in the right place at the right time.

d. This method is specific to the individuals who were recruited and the information gained cannot be generalized to others who don’t share these types of experiences.

e. None of the above biases best describe the sampling method chosen by the author.

3. What was the final sample size reported by the authors for this study?

a. 200 participants

b. 84 participants

c. 159 participants

d. 161 participants

4. Was a power analysis conducted? If so, which statement best describes the results of the power analysis?

a. The authors mention that an a priori power analysis was conducted, and 200 subjects were

determined to be needed for the study.

b. The authors mention that a power analysis was conducted using four predictors and 1-way ANOVA using three independent groups for a needed sample size of 159.

c. The authors do not report that a power analysis was conducted.

5. Which of these statements would be considered an inclusion criterion for the sample in the research article?

a. English-speaking

b. Have at least two years of experience as a nurse

c. Work on a Medical Surgical unit

d. Be a member of the Medical Surgical Nurses Association

6. Which of these statements would be considered to be exclusion criterion specifically identified by the author for the sample in the research article?

a. The exclusion criteria were explained verbally during recruitment.

b. History of depression/ mental health issue.

c. Report of no stress related problems by the participant.

d. Participants only worked on the night shift.

7. What is the refusal rate for this study? (Hint: see page 253 in your text)

a. 161/200 X 100% = 80%

b. 84/159 X 100% = 53%

c. unknown / cannot be calculated.

d. 39/200 x 100% = 19.5%

8. Which of the following would be accurate for the attrition rate for this study?

a. 161/200 X 100% = 80%

b. 39/200 X 100% = 20%

c. 84/159 X 100% = 53%

d. 0%

9. What was the setting for this research study? Briefly describe the setting and indicate whether it was appropriate for conducting this study.

a. The setting for this study was a partially controlled setting and was appropriate for this study’s research design.

b. The setting for this study was not well described by the authors and therefore not appropriate for

conducting this study.

c. The setting for this study was a highly controlled setting and was appropriate for this study’s research design.

d. The setting for this study was a natural or field setting and was appropriate for this study’s research design.

Question 10 – 14: Measurement Methods. (For help with these questions, refer to chapters 10 & 12.)

10. Which ones of these questionnaires, scales, or physiologic measures is used in this research study?

(Select all that apply).

a. The Ways of Coping Questionaire (WAYS)

b. The Nursing Stress Scale (NSS)

c. The Perceived Stress Scale (PSS)

d. The Quality of Life Scale (QOLS)

11. How do the authors describe the reliability of the Nursing Stress Scale (NSS) in previous studies?

a. Two follow-up emails were sent to potential participants.

b. they compared the odd and even questions on the test to determine their equivalence.

c. a team of staff nurses was trained by the primary investigator to administer the questionnaire.

d. they tested a group of subjects twice using the same questionnaire (test-retest reliability).

e. they computed a Cronbach’s alpha on the Nurse Stress Scale that was administered to this group of subjects.

12. How do the authors describe the validity of The Ways of Coping Questionnaire (WAYS).

a. discriminant validity demonstrated that each subscale measured the same constructs.

b. evidence of validity from contrasting groups because they gave it to spouses of MS nurses.

c. no was no mention of determining the validity of WAYS questionnaire.

d. The authors had experience with administering this questionnaire.

13. What types of questionnaires or surveys were used in this research study? (Select all that apply.)

a. The authors developed the Professional Quality of Life Scale.

b. Interviews were reportedly used, but the authors do not explain what was included in them.

c. The authors developed their own questions to ask about demographic information.

d. The authors report adding a few of their own questions at the end of the demographic questionnaire.

e. This study did not use any questionnaires or surveys.

f. The authors used previously developed questionnaires or surveys to measure the study

variables.

14. Were any physiological measurements collected from the subjects for the purpose of this study?

a. Yes

b. No

Question 15- 16: Data Collection. (For help with these questions, refer to chapters 10 & 12)

15. Which one of the following best describes the data collection process used in this study?

a. questionnaires / surveys were completed via the telephone.

b. participants were given the questionnaires on enrollment in the study and asked to drop the sealed envelope in a locked box at the nurse’s station.

c. questionnaires / surveys were mailed to the prospective participants and returned in a self-

addressed stamped envelope.

d. nurse researchers interviewed the study participants in a focus group.

16. If there were more than one data collector for the study, would an estimation of inter-rater reliability be an important concept for the authors to report on for this study?

a. yes, and the authors reported their efforts to achieve inter-rater reliability.

b. yes, but the authors do not discuss any efforts to achieve inter-rater reliability.

c. no, the issue of inter-rater reliability does not apply here.

Question 17 – 19: Data Analysis. (For help with these questions, refer to chapters 11 & 12)

17. What descriptive statistics are used in this study? (Select all that apply).

a. mean

b. median

c. mode

d. standard deviation

e. z-scores

f. percentage distributions

18. What inferential statistics were used to examine the data obtained from the subjects? (Select all that apply)

a. Bivariate correlational analysis

b. Factor Analysis

c. t-Test

d. Chi-Square

e. ANCOVA

f. ANOVA

g. regression analysis

h. None of the above inferential statistics were used in this study.

19. What is the level of significance (alpha) set at for this study?

a. .05 or 5%

b. .10 or 90%

c .01 or 1%

d. an alpha level or level of significance chosen by the authors was not specifically mentioned in the text

of the article.

Question 20-25: Researcher’s Interpretation of the Findings. (For help with these questions, refer to chapters 11 & 12)

20. There are several statistically significant findings in this study. Which of these statements from the article would be considered a significant and predicted result? (select all that apply)

a. As MS nurses’ perceptions of their stress increases, their use of ways to cope increases (r = .357, P<.00)

b. Younger nurses have lower levels of perceived stress, per post hoc Tukey analysis.

c. Baby boomers tend to report higher use of self-controlling behaviors than Gen X and Gen Y nurses when dealing with occupational stressors.

d. The stress perception level is thus determined by the type of occupational stressor that the nurse is

exposed to.

21. Which of these statements from the article would be considered a non-significant result. (Select all that apply)

a. The older the nurse, the higher the level of stress.

b. There was no difference between the scores on ways of coping related to age cohorts (F2158 = 1.12, P=.33)

c. Age, years of experience, and educational levels are not significant factors in levels of perceived stress among MS nurses.

d. Baby boomers tend to report higher use of self-controlling behaviors than Gen X and Gen Y nurses

when dealing with occupational stressors.

22. Which one of these statements from the article would be considered clinically important?

a. According to this study results, a high level of occupational stress is not a known factor for nursing

turnover in MS nurses.

b. Younger nurses have better coping skills to combat perceived stress compared to more

experienced nurses.

c. Baby boomers reported higher use of self-controlling behaviors when dealing with occupational

stressors compared with Gen X and Gen Y.

d. Six participants were removed from the study due to incomplete surveys.

23. Which statements below implied from the article would be considered a limitation of the study? (Select all that apply)

a. The researchers utilized a qualitative method in the research design.

b. Lack of standardization of the conditions of administering the instruments.

c. A small sample size with a low response rate.

d. A measure of social desirability in giving responses as the participants worked with the researcher.

24. Which one of these statements would be considered a statement regarding generalization of these results?

a. The results indicated that there were high levels of perceived stress in this group of MS nurses and can be generalized to all MS nurses in the United States.

b. The survey was mailed only to MS nurses who were members of the Medical Surgical Nurses Association (MSNA).

c. A convenience sample of MS nurses decreases generalizability.

d. The use of a power analysis influenced the generalization of the results to all MS nurses.

25. Which one of these statements from the article would be considered a recommendation for future studies? (Select al that apply.)

a. Future development of programs to help relieve the occupational stress in MS nurses.

b. Research to discover why older nurses have a higher perceived stress compared to younger nurses.

c. Sufficiently educating nursing leaders in generational differences.

d. Identification of occupational stressors, perceived stress, and coping styles among generational cohorts.

Case Study: Healing and Autonomy

Mike and Joanne are the parents of James and Samuel, identical twins born eight years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’ condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own, or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve.

The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then.

Two days later the family returned, and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James kidneys had deteriorated such that his dialysis was now not a temporary matter, and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches.

James’ nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’ brother Samuel.

Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney, or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? “This time around, it is a matter of life and death, what could require greater faith than that?” Mike reasons.

Write a 1,200-1,500 word analysis of “Case Study: Healing and Autonomy.” In light of the readings, be sure to address the following questions:

Under the Christian narrative and Christian vision, what sorts of issues are most pressing in this case study?

Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James?

According to the Christian narrative and the discussion of the issues of treatment refusal, patient autonomy, and organ donation in the topic readings, how might one analyze this case?

According to the topic readings and lecture, how ought the Christian think about sickness and health? What should Mike as a Christian do? How should he reason about trusting God and treating James?

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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 Turnitin. Please refer to the directions in the Student Success Center.

Question

1. One of the results of the 2005 Hurricanes Katrina and Rita in Louisiana has been an increase in the influx of Spanish-speaking workers. Incorporating cultural and linguistic competence to meet the health needs of this population would include

a. having health care professional staff from different Spanish-speaking countries at health care facilities.

b. ensuring health services are in varying locations.

c. ensuring that all signage is posted completely in Spanish.

d. having all health care workers speak Spanish.

2. A mechanism health care organizations need to incorporate into their strategic plan for culturally and linguistically appropriate services includes

a. goals, policies, accountability and oversight mechanisms addressing these services.

b. partnerships with community agencies.

c. mechanisms for client service reimbursement.

d. staff con? ict resolution policies.

3. Kwanzaa was created in the 1960s to raise awareness and pride for the African- American community. While its tenets can be applied to all people, this particular celebration was developed to celebrate a specific

a. social class.

b. religion.

c. ethnicity.

d. cultural group.

4. Parish Nursing is an aspect of nursing that is becoming more utilized. One of the bases of parish nursing is the premise that

a. it is easier to provide health services to a de? ned religious community.

b. a faith community has an impact on the health of its members.

c. illness is prevented through parish nursing.

d. members of a religion follow de? ned health practices.

5. After the Vietnam War, many Vietnamese immigrated to the United States and settled in areas where they could maintain many of the cultural customs and traditions of Vietnam, including festivals, Saturday schools to educate the children in the Vietnamese language and planting communal gardens. This is an example of

a. heritage consistency.

b. acculturation.

c. socialization.

d. religious preference.

6. A seminal event in the boomer generation that can still elicit comment today is the question

a. ”How did the Challenger tragedy affect you?”

b. ”Where were you when John F. Kennedy was shot?”

c. ”Do you remember Pearl Harbor?”

d. ”What were you doing on September 11, 2001?”

7. A complaint of the boomer generation about the following generations regards work ethic. The “nester” generation born between 1979 and 1984 is more likely to embrace an ethic

a. of employer loyalty.

b. seeking to fit their lifestyle.

c. seeking maximum financial gain.

d. loyal to one’s skills in the marketplace.

8. The best outcome for health care facilities incorporating cultural care into their practices is

a. increased numbers of clients seeking care at these facilities.

b. improved health outcomes for the clients at these facilities.

c. better health care provided by the facility’s staff.

d. increased reimbursement by insurance companies for provided health services.

9. An important consideration when making a home health visit to a client is to:

a. give a general idea of when the visit will be made.

b. bring a gift to the client’s home on the initial visit.

c. just show up at the client’s home.

d. inform the client the approximate time the visit will be made.

10. Certain cultures place emphasis on eating speci? c foods during pregnancy and after childbirth to ensure a healthy mother and infant. This cultural phenomena is an example of

a. time orientation.

b. environmental control.

c. biological variation.

d. social organization.

11. Touch is an important component of nursing, but using it without understanding the client’s cultural background can be a violation of their

a. social organization.

b. environmental control.

c. space and territoriality.

d. time orientation.

12. Before doing any teaching it is important the client understands what is being taught. The most effective method to determine if the client understands any health teaching is by

a. ask the client if they understand what was said in the teaching.

b. speaking slowly and carefully to the client.

c. having the client repeat back what was said in his/her own words.

d. interpreting the client’s facial gestures.

13. Native Americans have a higher susceptibility to diabetes than other population groups within the United States. This is considered a(n)

a. biological variation.

b. component of heritage consistency.

c. social organization pattern.

d. environmental control.

14. While the Census Bureau has placed race as a sociopolitical construct, placing oneself into a racial category can still present a challenge. Those who consider themselves “Creole” would be more likely to place themselves into the category labeled

a. White.

b. Asian.

c. Black or African American.

d. Hispanic or Latino.

15. While shifts in the population profile are occurring, what is an important consideration to address in health care?

a. More physicians need to be trained to deliver health care.

b. Cultural health needs of varying groups must be considered.

c. Health care providers need to be younger to care for an aging population.

d. Health care needs to be streamlined for consistent care delivery.6

16. With the percentage of the 65+ population greatest among White non-Hispanics in the 2000 Census, health planning needs would indicate

a. there is no need to increase manufacture of childhood immunizations.

b. cultural accommodations for other minority groups can be decreased.

c. planning needs for other segments of the population can be revised downwards.

d. this population will have greater demands on the health care system as they age.

17. Twelve percent of the population in 2000 was age 65 or over. Long-term implications for health for this group include

a. developing systems to provide health care only to those older citizens who remain healthy.

b. providing health care that is focused on gerontological needs.

c. providing health insurance for all age groups.

d. developing medications to prolong life at any cost.

18. A hurdle immigrants face coming to a new country is

a. rejecting their old customs in favor of new customs.

b. having their children learn the customs of the new country.

c. finding their own cultural group in the new country.

d. learning a new way of life that differs from their former way of life.

19. In 1970, the highest percentage of foreign-born legal permanent residents becoming citizens came from Europe. What is true today? The majority of foreign-born legal permanent residents are from

a. Asia.

b. Mexico, China, and the Philippines.

c. Europe.

d. South America.

20. Many people who come to the United States to live seek to get a “green card.” The green card

a. confers automatic U.S. citizenship.

b. legally restricts the holder from becoming a citizen.

c. defines the person as being in the country unlawfully.

d. allows the person legal permanent residency.

21. When seeking permanent U.S. citizenship, legal permanent residents take a naturalization exam that questions them on

a. knowing the Pledge of Allegiance.

b. being able to recite or sing the national anthem.

c. elements of the U.S. government.

d. the Congressional district they live in.

22. Among the very real concerns for all residents of the United States, citizens and legal permanent residents, is the rise in undocumented people entering the country. What impact is this having on health care?

a. Increased numbers of undocumented people are straining health care resources.

b. The rise in undocumented people is contributing to the rise in exotic and rare diseases in the country.

c. There is a concern that undocumented people will lead to bioterrorist attacks.

d. Health insurance is being given to all people in the country ensuring universal coverage.

23. One recognized deterrent to poverty is

a. the presence of two parents in a family structure.

b. not needing to have housing assistance.

c. not needing to utilize food stamps.

d. living in a household of a male income earner.

24. While income is not a restrictor for engaging in health-promoting behaviors, higher income improves them through

a. living in better housing.

b. membership in health clubs in suburban areas.

c. increasing opportunities through nutrition and access to facilities.

d. access to better jobs.

25. Many people and groups have provided definitions of health, but the most widely used definition is that from

a. Nightingale.

b. Rogers.

c. Murray and Zenter.

d. WHO (World Health Organization

26. As people progress through a health profession education program, definitions of health become

a. easier to explain to others.

b. aligned with the client seeking care.

c. more abstract and technical.

d. well articulated and understandable.

27. In attempting to define health, what can occur?

a. Listing categories of health will enable understanding of health.

b. Ambiguity is resolved when health definitions are discussed.

c. Terms and meanings can be challenged by others.

d. A full acceptance can be achieved by all parties.

28. Health status and determinants are used to

a. account for health care expenditures.

b. enforce legislation pertaining to health.

c. determine federal dietary guidelines.

d. measure the health of a nation.

29. Healthy People 2010 represents

a. health policies providing monetary incentives to states who reach the benchmark goals by 2010.

b. a plan to improve the health of everyone in the United States in the ? rst decade of this century.

c. mandated legislation that will result in a healthier population by 2010.

d. a monitoring system evaluating the health of all citizens.

30. As with the many variant definitions of health, illness also has many meanings. Illness and the sick role assigned to it are legitimized by

a. the insurance company that pays for the illness treatment.

b. the person having the illness.

c. the health care profession that diagnoses the illness.

d. society’s view of the illness.

31. Among the sick role components is the

a. mandate of appearing ill and suffering from the illness.

b. necessity of taking medications and staying in bed.

c. exemption from performance of certain normal social obligations.

d. refusal to look to other sources of health care treatments beyond those prescribed.

32. During the stage of patient status, it is expected that

a. symptoms are being experienced, leading to a diagnosis.

b. the patient do all they can do to recover from their illness.

c. the illness is now socially recognized and identified.

d. the person shifts into the role as it is determined by society.

33. Assuming the sick role according to Suchman means the person

a. is aware that something is wrong and responds emotionally.

b. seeks scientific confirrmation that something is wrong.

c. seeks help and shares the problem with family and friends.

d. goes under the control of a physician who plans a treatment of care.

34. A person who has cancer may have followed this illness trajectory:

a. presenting symptoms, followed by treatment and recovery.

b. acute illness, unstable status, deterioration, and recovery.

c. diagnosis, treatment, unstable status, death.

d. presenting symptoms, followed by diagnosis and treatment.

35. When Suchman divides the illness experience into its various stages, the medical care contact stage implies the person is

a. cognitively and physically aware that something is wrong.

b. under medical control and following a prescribed treatment protocol.

c. seeking scientific c rather than lay diagnosis in order to interpret what it all means.

d. seeking help and information from family and friends. 10

36. While HEALTH is considered a balance of the person, ILLNESS would be considered

a. the imbalance of one’s being in and outside the world.

b. actual symptomatology physically manifested.

c. part of the human condition that all must experience.

d. the absence of elements that contribute to health.

37. While complementary alternative medical (CAM) treatments are used by people of all backgrounds, recent research indicates CAM use is greater by

a. men.

b. those who have never been hospitalized.

c. people with rudimentary education.

d. women.

38. Alternative medical traditions are considered

a. an essential component of a cultural heritage medical tradition.

b. for use in concert with other aspects of health care.

c. out of the realm of a person’s cultural heritage medical tradition.

d. traditional methods of health care.

39. The evil eye is defined differently by different populations. Evil is thought to be cast in the Philippines through the

a. mouth or eye.

b. eye or touch.

c. foot.

d. breath.

40. The saying, “An apple a day keeps the doctor away, an onion a day keeps everyone away,” is thought to protect HEALTH by

a. recognizing the special antibiotic properties contained within onions.

b. advertising that onions have special healing abilities.

c. protecting the person from coming in contact with those who might be ill.

d. affirming the belief in the power of onions to prevent disease.

41. Religion has an important role in HEALTH, and ILLNESS can be considered

a. violating dietary practices.

b. failure to wear special amulets to ward it off.

c. a necessary part of religious culture.

d. punishment for breaking a religious code.

42. Eucalyptus is a folk herbal remedy that has applications today. It is used for

a. nasal congestion and sore throat.

b. infant colic.

c. toothache pain.

d. fever.

43. Allopathic medicine terms alternative treatments as complementary or alternative. An alternative therapy for rehabilitation might include ________ as treatment.

a. macrobiotics

b. Santeria

c. Voodoo

d. biofeedback

44. The difference between complementary and alternative medicine is that complementary medicine

a. can be used together with allopathic medicine.

b. is never used with allopathic medicine.

c. lessens a patient’s discomfort with allopathic treatments.

d. replaces allopathic medicine as a primary form of treatment.

45. A reason why people seek alternative care treatments is

a. allopathic treatments may cause adverse effects that a person can’t tolerate.

b. training for alternative care practitioners is closely regulated and licensed.

c. insurance reimburses alternative care treatments at the same rate or better than allopathic treatments.

d. it has a better empirical basis than do allopathic treatments.

46. Many people of Catholic faith pray to ________ for the grace of a happy death.

a. St. Teresa of Avila

b. St. John of God

c. St. Roch

d. St. Joseph

47. While shrines that attract pilgrims can be religious or secular in nature, an essential component to all of them is the

a. feeling of peace and serenity that is conducive to healing.

b. location of the shrine.

c. presence of water so pilgrims can take samples home.

d. numbers of people who are attracted to that site.

48. Lourdes, France, is the site of a revered Roman Catholic shrine. Many people with illnesses visit the shrine with the hope of

a. becoming more prosperous.

b. gaining a better job.

c. receiving a cure through a miracle.

d. being able to live a long life.

49. Historically, early forms of HEALING for illness were equated with

a. performing set rituals to prevent illness.

b. finding the person causing the illness.

c. sacrificial offerings.

d. removing the evil causing the illness.

50. Among alternative treatment modalities utilized during an illness may be the

a. consultation of a healer outside the medical establishment.

b. strict adherence to the prescribed medical regimen.

c. willingness to seek a second medical opinion.

d. refusal to allow any medical treatment to be performed.