Archive for month: June, 2019

Question: The coronary ostia are located in the:

2. Question: Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants?

3. Question: Decreased lung compliance means that the lungs are demonstrating which characteristic?

4. Question: What is the life span of an erythrocyte (in days)?

5. Question: Infants are most susceptible to significant losses in total body water because of an infant’s:

6. Question: Causes of hyperkalemia include:

7. Question: Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia?

8. Question: The lung is innervated by the parasympathetic nervous system via which nerve?

9. Question: When an individual aspirates food particles, where would the nurse expect to hear decreased or absent breath sounds?

10. Question: Which T-lymphocyte phenotype is the key determinant of childhood asthma?

11. Question: What is the final stage of the infectious process?

12. Question: How is most of the oxygen in the blood transported?

13. Question: When a patient has small, vesicular lesions that last between 10 and 20 days, which sexually transmitted infection is suspected?

14. Question: An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody?

15. Question: Which congenital heart defects occur in trisomy 13, trisomy 18, and Down syndrome?

16. Question: What is the functional unit of the kidney called?

17. Question: Which of the following is classified as a megaloblastic anemia?

18. Question: What are the abnormalities in cytokines found in children with cystic fibrosis (CF)?

19. Question: The only surface inside the nephron where cells are covered with microvilli to increase the reabsorptive surface area is called the:

20. Question: Between which months of age does sudden infant death syndrome (SIDS) most often occur?

21. Question: What is the primary site for uncomplicated local gonococci infections in men?

22. Question: Which organism is a common sexually transmitted bacterial infection?

23. Question: The drug heparin acts in hemostasis by which processes?

24. Question: What is the primary cause of respiratory distress syndrome (RDS) of the newborn?

25. Question: An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect?

26. Question: Hemolytic disease of the newborn (HDN) can occur if the mother:

27. Question: Blood vessels of the kidneys are innervated by the:

28. Question: What is the most common cause of insufficient erythropoiesis in children?

29. Question: If the sinoatrial (SA) node fails, then at what rate (depolarizations per minute) can the atrioventricular (AV) node depolarize?

30. Question: Hypersensitivity is best defined as a(an):

31. Question: Which criterion is used to confirm a diagnosis of asthma in an 8-year-old child?

32. Question: How is most carbon dioxide (CO2) in the blood transported?

33. Question: When the bladder accumulates 250 to 300 ml of urine, it contracts and the internal urethral sphincter relaxes through activation of the spinal reflex arc (known as the micturition reflex).

34. Question: Which cells have phagocytic properties similar to monocytes and contract like smooth muscles cells, thereby influencing the glomerular filtration rate?

35. Question: Which statement best describes a Schilling test?

36. Question: Fetal hematopoiesis occurs in which structure?

37. Question: Which disorder results in decreased erythrocytes and platelets with changes in leukocytes and has clinical manifestations of pallor, fatigue, petechiae, purpura, bleeding, and fever?

38. Question: What is the life span of platelets (in days)?

39. Question: What is the ratio of coronary capillaries to cardiac muscle cells?

40. Question: Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen?

41. Question: The most common site of metastasis for a patient diagnosed with prostate cancer is which location?

42. Question: During an IgE-mediated hypersensitivity reaction, which leukocyte is activated?

43. Question: In which primary immune deficiency is there a partial-to-complete absence of T-cell immunity?

44. Question: Innervation of the bladder and internal urethral sphincter is supplied by which nerves?

45. Question: What effects do exercise and body position have on renal blood flow?

46. Question: Which blood cell type is elevated at birth but decreases to adult levels during the first year of life?

47. Question: It has been determined that a tumor is in stage 2. What is the meaning of this finding?

48. Question: Research supports the premise that exercise has a probable impact on reducing the risk of which cancer?

49. Question: Where in the respiratory tract do the majority of foreign objects aspirated by children finally lodge?

50. Question: What is the most common cause of iron deficiency anemia (IDA)?

51. Question: Which type of antibody is involved in type I hypersensitivity reaction?

52. Question: Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)?

53. Question: Which cytokines initiate the production of corticotropin-releasing hormone (CRH)?

54. Question: What is the major concern regarding the treatment of gonococci infections?

55. Question: What part of the kidney controls renal blood flow, glomerular filtration, and renin secretion?

56. Question: Examination of the throat in a child demonstrating signs and symptoms of acute epiglottitis may contribute to which life-threatening complication?

57. Question: The function of the foramen ovale in a fetus allows what to occur?

58. Question: Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot to relieve hypoxic spells?

59. Question: Perceived stress elicits an emotional, anticipatory response that begins where?

60. Question: Which term is used to identify the movement of gas and air into and out of the lungs?

As a future advanced practice nurse, it is important that you are able to connect your didactic experience to your Practicum experience. By applying the concepts you study in the classroom to clinical settings, you better prepare yourself for your future professional career. Each week, you complete an assignment that prompts you to reflect on your Practicum experiences and relate them to the material presented in the classroom.

To prepare for this course’s Practicum experience, address the following in your Practicum journal:

Explain what most excites and/or concerns you about pediatric clinical experiences. Include a description of your strengths and weaknesses in terms of working with children and how these strengths and weaknesses might impact your Practicum experience.

As a future advanced practice nurse, it is important that you are able to connect your didactic experience to your Practicum experience. By applying the concepts you study in the classroom to clinical settings, you better prepare yourself for your future professional career. Each week, you complete an assignment that prompts you to reflect on your Practicum experiences and relate them to the material presented in the classroom.

To prepare for this course’s Practicum experience, address the following in your Practicum journal:

Explain what most excites and/or concerns you about pediatric clinical experiences. Include a description of your strengths and weaknesses in terms of working with children and how these strengths and weaknesses might impact your Practicum experience.

Select and explain a nursing theory to guide your practice with pediatric patients.

Based on your strengths, weaknesses, and theory of nursing practice, develop goals and objectives for the Practicum experience in this course. Be sure to consider the NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice from this week’s Learning Resources.

Create a timeline of Practicum activities based on your Practicum requirements.

Based on your strengths, weaknesses, and theory of nursing practice, develop goals and objectives for the Practicum experience in this course. Be sure to consider the NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice from this week’s Learning Resources.

Create a timeline of Practicum activities based on your Practicum requirements.

Topic 1: Case Study

Case Study Posting Requirements

Make sure all of the topics in the case study have been addressed.
Cite at least three sources—journal articles, textbooks or evidenced-based websites to support the content.
All sources must be within five years.
Do not use .com, Wikipedia, or up-to-date, etc., for your sources.
Case Study 1

Organization and Control of Neural Function

Riku is a 19-year-old college student. One morning, after a long night of studying, Riku woke up and made himself a hot cup of coffee and toast.

Much to his surprise, when he brought the cup to his mouth to drink, the coffee spilt onto the table. Riku went to the bathroom mirror and noticed the left side of his face seemed to droop. He quickly got dressed and ran to the medical clinic on the college campus. As he ran, his left eye began to feel scratchy and dry, but he could not blink in response. The physician at the clinic listened to Riku’s story and then did a careful cranial nerve examination. She concluded that Riku had Bell palsy, an inflammatory condition of the facial nerve most likely caused by a virus.

What are an afferent neuron and efferent neuron? What are efferent components of the facial nerve and their actions?
Under certain circumstances, axons in the peripheral nervous system can regenerate after sustaining damage. Why is axonal regeneration in the central nervous system much less likely?
At a healthy myoneural junction, acetylcholine is responsible for stimulating muscle activity. What mechanisms are in place to prevent the continuous stimulation of a muscle fiber after the neurotransmitter is released from the presynaptic membrane?
Case Study 2

Somatosensory Function, Pain, and Headache

Ramandeep is an active 23-year-old. She works as a part-time nurse during the day and is studying for a postgraduate certificate in the evening. Ramandeep started to wear a bite plate at night after she began to experience jaw pain and headaches. Sometimes the pain radiated to her ear, and she would apply a hot water bottle to it to ease the discomfort. Her husband mentioned to her that he heard her grinding her teeth at night while she was sleeping. She knew then that her headaches might be from temporomandibular joint syndrome, and she went to her dentist to confirm her thoughts. In addition to the bite plate, the dentist also recommended she should continue with the application of heat, use NSAIDs when needed, and incorporate regular relaxation exercises throughout her stressful days.

What effect does heat have on nociceptors so that it makes a good nonpharmacologic treatment for pain?
Heat and cold treatment are both hypothesized to have an effect on the release of endogenous opioids. What are these chemicals, and why are they hypothesized to be beneficial in the body?
Using your knowledge of physiology, how do NSAID analgesics function in the management of pain?
Case Study 3

Disorders of Motor Function

John is 63 years old and receives home care by an occupational therapist twice a week. His therapist is currently working with John on maintaining joint flexibility and balance. John demonstrates resting tremor, so his therapist is also working on adaptive techniques, so John can continue to use his hands to write, use the computer, and cook simple meals. John’s wife assists with his mobility and walks slowly beside him, holding his arm. Sometimes she needs to help him open his prescription bottles, so he can take his medicine, a combination of levodopa and carbidopa.

What motor disease does John demonstrate? One of his signs is resting tremor. What is the difference between a resting tremor and an intention tremor?
What is the advantage of combining levodopa with carbidopa? What is the benefit of anticholinergic drugs in the management of Parkinson disease?
Parkinson disease involves the destruction of the substantia nigra and the nigrostriatal pathway. Where are these structures anatomically?
The patient with Parkinson disease typically presents with a masklike facial expression. Why does he or she have a masklike facial expression? How are the eyes, mouth, and laryngopharynx affected by this disease?
Case Study 4

Disorders of Brain Function

Bonnie is a 70-year-old woman who lives alone. One evening, she felt light-headed and dizzy. When her head began to ache, she decided to take an analgesic and go to bed early. The following morning, upon awakening, she was unable to move the bed sheets with her right arm. At this point she was experiencing tingling sensations in her limbs, and she had difficulty keeping her balance. She dialed 911 for help, and by the time the ambulance arrived, she was confused and unable to articulate her words although she knew what information he was asking of her. In the hospital, she was examined and treated for ischemic stroke.

Stroke, or brain attack, involves brain tissue injury. Describe ischemic penumbra and what factors contribute to the survival of the neurons involved. What happens if the cells of the penumbra are unable to be preserved?
Compare and contrast hypoxia and ischemia. What condition is more dangerous to the brain? Explain your answer.
Knowing what you do about the effects of ischemia on the brain, why would someone with ischemic stroke develop cerebral edema?
What type of aphasia was Bonnie exhibiting when talking to her caregivers? Explain your answer.
Case Study 5

Sleep and Sleep Disorders

Jessica is six years old. Her parents recently saw her pediatrician because they were concerned about the sleeping difficulties Jessica has been having. Often she would scream out loud in her sleep. Her parents would rush to her room and find her sitting upright in bed, panting heavily in a state of panic. Jessica would not respond to her parent’s words of consolation, and the next morning she would have no memory of the incident at all. Her parents were worried about the anxiety their daughter was experiencing and asked the pediatrician what they could do about her nightmares. The pediatrician explained Jessica was likely suffering from sleep terrors and carefully described what that meant.

What are the similarities and differences between nightmares and sleep terrors?
What are the characteristics of motor, sensory, and autonomic function during REM sleep? What is thought to be the importance of this stage of sleep?
Jessica’s pediatrician said that the careful management of sleep hygiene may help to decrease the incidence of her sleep terrors. What is included in an overview of the general features that demonstrate good sleep hygiene?
Case Study 6

Disorders of Thought, Emotion, and Memory

Ella is 88 years old and was living at home until very recently. Her children, who visited her regularly, noticed she was becoming more forgetful. At first, she mislaid objects, and then she began to forget her doctor’s appointments. With time, her personality changed and she became withdrawn. At home she would forget to turn off the stove or leave the kettle on until it boiled dry. After seeking advice from a gerontologist and social worker, Ella’s children placed her in a nursing home with a unit equipped for patients with Alzheimer disease.

What is dementia? Why is Alzheimer disease based on a “diagnosis of exclusion”?
What are the macroscopic and microscopic features of the brain that are typical in Alzheimer disease?
One of Ella’s children brought her a new pair of slippers to wear in the nursing home. A minute after she received them, Ella could not remember the exchange and asked what they were doing on her bed. What part of the brain has largely been affected to produce this behavior, and what is the pathophysiology involved?

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

Case Scenario

Mr. C., a 32-year-old single man, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He reports that he has always been heavy, even as a small child, but he has gained about 100 pounds in the last 2–3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control with sodium restriction. He current works at a catalog telephone center.

Objective Data

Height: 68 inches; Weight 134.5 kg

BP: 172/96, HR 88, RR 26

Fasting Blood Glucose: 146/mg/dL

Total Cholesterol: 250mg/dL

Triglycerides: 312 mg/dL

HDL: 30 mg/dL

Critical Thinking Questions

What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?

Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered:

Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.

Ranitidine (Zantac) 300 mg PO at bedtime.

Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.

The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.

Assess each of Mr. C.’s functional health patterns using the information given. (Hint: Functional health patterns include health-perception – health management, nutritional – metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception – self-concept, role-relationship, sexuality – reproductive, coping – stress tolerance.)

What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.