NSG6435 Week 5 Assignment 4 Midterm Exam / NSG 6435 Week 5 Midterm Exam -Family Health - Pediatrics- South University
NSG6435 Week 5 Assignment 4 Midterm Exam / NSG 6435 Week 5 Midterm Exam -Family Health - Pediatrics- South University
The incidence of congenital heart defects is estimated to be ________ of all live births.
Breastmilk can be safely stored in a freezer below 0 degrees Fahrenheit for how long?
Which foreign body needs immediate removal from a five-year-old boy’s nose?
The most useful diagnostic test in delayed puberty is _____________________.
complete thyroid panel
X-Ray of the left wrist and hand
X-Ray of the right wrist and hand
X-Ray of the spinal column
An average vision of a two-year-old child is approximately:
A five-year-old female presents for a follow-up emergency room visit with a diagnosis of bronchitis. You would expect which treatment to have been prescribed?
Increase rest and fluid
An adolescent with a chronic asthma cough notes that symptoms are usually worse _____________.
only with exertion
only during the daytime
only at night
at night and with exertion
An average adolescent female usually experiences her biggest growth spurt at approximately what age?
Ten and half years
Eleven and half years
Twelve and half years
Thirteen and half years
If an adolescent has a bone age of 10 but is actually 13 years of age, this patient has ______.
an increased risk of fracture in the next three years
an increased risk of osteoporosis as an adult
a higher potential for bone growth
a lower potential for bone growth
Gardasil results in greater antibody responses for females who are administered the three-dose series between what ages?
Six to twenty-six years of age
Prior to eleven years of age
Nine to fifteen years of age
Nine to twenty-six years of age
An eight-year old has chronic intermittent nasal congestion. All but which of the following would support allergic rhinitis?
Red swollen turbinates
Darkened areas below eyes
Increased basophils on complete blood count (CB
Itchy, watery eyes
A fifteen-month old failed treatment with amoxicillin for an otitis media. At his two-week recheck, his tympanic membrane remained red with distorted landmarks and he persisted with nasal discharge that is thick and yellowish. The best action for the nursing practitioner should be to prescribe:
A ten-day-course of augmentin
A three-week-course of a cephalexin
A higher dose amoxicillin
Ceftriaxone and an antihistamine
An infant should be able to say his or her first word by:
four to five months
eight to nine months
twelve to fifteen months
twenty four to twenty six months
The latter part of adolescence includes the ability to develop ________ and _______ means to be a part of society.
strong attachments; sexuality
critical thinking; basic life skills
moral; intellectual means
A fourteen-year-old adolescent presents with fatigue, endocarditis, pulmonary hypertension, arrhythmias, and congestive heart failure. You suspect he may have ____________.
pulmonary valve stenosis
aortic valve stenosis
a ventricular septal defect (VSD)
A four-year-old male patient presents with his mother with a school referral regarding red eyes. Which questions would not assist in establishing a list of differential diagnoses?
Unilateral vs. bilateral presentation
Type of drainage
History of a bacterial infection one month ago
______________ adolescents should be screened for sexually transmitted diseases.
An infant should no longer have a head lag when pulled from the supine to sitting position at what age?
____________ should be given as a supplement in the management of delayed puberty.
Vitamins B1 and B12
Vitamins D and E
Vitamin A and Calcium
Calcium and Vitamin D
Parents or guardians of adolescents should ___________________.
not be included in the adolescent's health care
receive health guidance information at least twice during adolescence
encourage reasonable use of alcohol and tobacco by the adolescent
encourage early sexual activity by providing condoms to the adolescent
How does cultural sensitivity impact the care of infants in the primary care setting?
Health-care providers may possess cultural biases that can impact care.
Cultural sensitivities do not exist in health care.
Cultural sensitivity only impacts the parents of infants.
Cultural sensitivity increases access to timely health-care services for infants.
The most typical chest radiographic finding consistent with the diagnosis of asthma is ______________.
normal chest film
diffuse airway edema
right upper-lobe infiltrate
A 10 yo has a single painful ulcerated lesion on an erythematous base on the inner buccal mucosa. The most likely diagnosis and treatment would be:
herpes simplex stomatitis--oral acyclovir
apthous ulcer--triamcinalone in orabase
Hand, foot, mouth syndrome--antibiotic mouthwash
A 9 month old is noted to have a bifid uvula. This would increase his risk of developing which disorder?
All of the following may predispose a patient to thrush except:
poor oral hygiene
Patients with sinusitis should be instructed not to participate in what activity?
cross country running
What complication of sinusitis are adolescent males more prone to?
potts puffy tumor
Acceptable management options for allergic rhinitis include all of the following except:
A 7 yo has experienced recurrent nose bleeds in the past 2 months. What finding on the physical exam would suggest an underlying medical cause for the epistaxis?
grade II murmur
A 2 yo male with a history of chronic serous OM is noted to have a pearly white opacity in the upper outer quadrant of his TM. He currently has no symptoms and appears to be ok. The most likely diagnosis and appropriate managment would be:
tympanosclerosis; no treatment is necessary
persistent perforation; prescribe topical antibiotic drops
foreign body; perform an ear wash for removal
cholesteatoma; refer to otolaryngology
A 15 mo failed treatment with amoxicillin for OM. At his 2 week re-check his TM remained red with distorted landmarks and he persisted with nasal congestion, poor sleep, and fever. The next best step would be to treat with:
a 10 day course of augmentin
a 3 week course of cephalosporin
a higher dose of amoxicillin and topical abx
ceftriaxone and an antihistamine
All but which one of the following patients are at an increased risk of developing otitis media?
2 yo with cleft palate repair at 1 year of age
15 mo with down syndrome
9 mo with lactose intolerance
3 yo with IgA immune deficiency
Patients with otitis externa should be instructed to do which one of the following:
keep ear dry until symptoms improve
limit swimming for the remainder of summer
wear ear plugs at all times with swimming
use alcohol drops before swimming each day
A 10 yo has marked ear pain, not wanting anyone to touch his ear. The canal is edematous and exudate is present. TM is normal. How should this be managed?
oral steroids and topical neomycin
oral amoxicillin and topical anesthetic
oral amoxicillin and topical steroid
A 16 yo was hit in the eye 1 day ago and now has ecchymoses on the upper and lower lids with 5/10 eye pain. All but which of the following would be appropriate to obtain at this time:
The greatest risk in a patient with a hyphema is which of the following?
Corneal abrasions can be managed with topical application of which of the following:
anesthetic for pain control
steroids to prevent adhesions
antibiotics to prevent infection
atropine to prevent ciliary spasm
Trauma to the eye increases the risk of developing all but which one of the following?
Fluorescein staining of the eye is used to detect a:
Prematurity increases the risk of developing which one of the following?
A 3 month old has a mild asymmetrical corneal light reflex on physical exam. What is the next appropriate step?
observe and reevaluate at the next well check
refer immediately to ophthalmology
begin atropine drops or eye patching
protect eyes from sunlight
Which of the following may cause microcephaly?
What finding may accompany macrocephaly?
Pulsating anterior fontanel
Premature closure of suture lines
Widened suture lines
Obtaining a CT of the head would be indicated in which of these conditions?
Which one of the following conditions increases the risk of developing hydrocephalus?
A conjunctivitis appearing in a 2 day old newborn is likely due to:
chemical irritation from eye drops
group B streptocuccus
Confirming the diagnosis of chlamydia conjunctivitis in a newborn would best be done by obtaining which one of the following?
cervical swab of the mother
urine PCR from the mother
culture of the eye discharge
culture of the conjunctival scrapings
Which one of the following eye findings would be considered an ophthalmic emergency?
unilateral vesicular lesions on the upper eyelid of a 3 week old
presence of chemosis in a 5 yo with bilateral upper eyelid edema
cobblestone-like appearance along the inner aspect of the upper eyelid in a 15 yo
bilateral redness along the eyelid margins with tiny ulcerated areas in a 16 yo
The most appropriate management of a 5 yo with a firm, nontender nodule in the mid-upper eyelid for 3 weeks would be:
topical ophthalmic ointment
Daily eyelid cleansing with diluted baby shampoo and a cotton tipped applicator would be appropriate in the treatment of which one of the following conditions?
A 3 year old has an edematous, mildly erythematous right upper eyelid for one day with a fever of 103. An important eye assessment would be:
optic disk papilledema
Concurrent otitis media and conjunctivitis is likely due to which organism?
A 16 yo girl makes the following statements to you during her health visit. Which of the following pieces of information should not be kept confidential?
I have been sexually active with three of my boyfriends
I sometimes smoke marijuana
I want to get pregnant
Sometimes I feel like ending my life
In performing a physical examination on a nine month old infant, which of the following developmental fears would not be appropriate for you to consider?
Separation from parents
When performing a physical examination on a toddler, which of the following body parts would you examine last:
Heart and lungs
abdomen and genitals
Ears and throat
Hips and extremities
Role play with equipment during the course of a physical examination would be most beneficial with which of the following age groups:
Young school-age children
Older school-age children
Providing reassurance of "normalcy" during the course of an examination would be most important for:
Young school-age children
Older school-age children
Which of the following would not elevate the pulse of a child:
The PNP recognizes which of the following signs as indicators that baby is not receiving sufficient breastmilk?
Sleepiness, jaundice, decreased urine and stool
Diarrhea, nausea, and vomiting
Bulging fontanel and irritability
Sleeplessness and excitability
Blood pressure should be measured at WCC beginning at age:
A wide pulse pressure that results from a high systolic blood pressure is usually not due to which of the following:
A patent ductus arteriosus
Head and chest circumferences should be equal at:
The anterior fontanel usually closes by:
Diffuse edema of the soft tissue of the scalp which usually crosses suture lines in the newborn is:
An infant should no longer have head lag when pulled from the supine to sitting position at what age?
"Boggy" nasal mucous membranes with serous drainage upon examination usually suggests:
A white instead of red reflex upon eye examination of a 1 yo child would suggest:
An accommodative error
A cobblestone appearance of the palpebral conjunctiva usually indicates:
An eye that deviates in when covered but returns to midline when uncovered is an:
Pain produced by manipulation of the auricle or pressure on the tragus suggests:
Acute otitis media
Otitis media with effusion
A hypernasal voice and snoring in a child is suggestive of:
Polyps of the larynx
Physiological splitting of the second heart sound during inspiration in a child:
should be evaluated with an EKG
Should be referred to a cardiologist
Which of the following is not characteristic of innocent heart murmurs in children?
Systolic in timing
Varies in loudness with positioning
Usually transmitted to the neck
Usually loudest at lower left sternal border or at second or third intercostal space
A grade II musical or vibratory murmur heard best at the lower left sternal border that changes with positioning is suggestive of a:
Pulmonary ejection murmur
Ventricular septal defect
Vibratory or Still's murmur
Wheezing in a child may not be found in which of the following conditions:
Pleural friction rub
Gynecomastia in a male may not be a finding in which of the following:
Normal pubertal development
Which of the following would usually not be considered a sign of a pituitary tumor in an adolescent female?
Dysfunctional uterine bleeding
Loss of peripheral vision
Increase in headaches
Which of the following is not a specific examination test for a dislocated hip?
In addition to the knee, which of the following should be examined in a child complaining of knee pain?
Which of the following infant reflexes should not disappear by 6 months of age?
Spasticity in an infant may be an early sign of:
A shift to the left is present when which of the following are elevated?
Bands or stabs
Which of the following is usually elevated with viral infections?
Decreased platelets may not be found in which of the following:
Idiopathic thrombocytopenic purpura
Medication usage (e.g. ampicillin, cephalothin)
Which of the following does not suggest a urinary tract infection?
Summary Economics of Health and Health care all lectures
Extensive summary of all lectures, including all relevant graphs, notes from the exercise lectures and the mandatory literature.
Economics Of Health and Health Care (2018-2019) - Lectures Summary
This course builds on Economics and Financing of Health Care, in which the principles of health economics and health care financing are explained. This course uses some of the tools and concepts discussed in that course to analyse and compare health and health care at the macro or system level. The performance of health care systems may be evaluated by analysing whether the outcomes are efficient and equitable. Therefore, this course consists of three parts. The first part is about the relationships between health, health care and income. Understanding these relationships is an important goal in its own right, but also provides some of the building blocks that are necessary for the definition and measurement of equity (part 2) and efficiency (part 3). In each of the three parts, the main focus is on applying the analytical framework – and evaluating how other researchers have applied it – to compare the performance of developed and less developed countries and discuss the aspects of health care systems and their performance in a structured manner.
Students are expected to have agood basic understanding of microeconomics and health economics. That is, students are expected to be familiar with concepts such as opportunity costs, economies of scale and scope and purchasing power parity.
Assignment #4: Health care case analysis
Assignment #4: Health care case analysis (25 Points) - Due
Oct 11, 2015 11:30 PM
HMGT 372 6380 Legal and Ethical Issues in Health Care (2158)
The final project for this course is an analysis of the legal and or ethical issues involved in the below health care scenario. See questions to be answered at end of this factual scenario below. I have also provided, after the formatting requirements for the paper, two articles that will aid you in your analyzing the scenario and writing your paper.
The two articles to base the analysis of your paper are entitled:
Clinical Ethics Issues and Discussion and
A Framework for Thinking Ethically
This is the final paper for the class and must be double spaced and be approximately 4-6 pages in 12 point New Times Roman font. Include a cover page [not counted as a page] which should have student name and title of your paper. See more formatting requirements later in these paper instructions.
NOTE: For this paper it is unnecessary to do any research beyond the two articles I furnished with this assignment. Both are after the specific paper requirements. You may use all the articles in the class but you will be wasting your time to do internet research.
A 72 year old woman was admitted to the Neurological Intensive Care Unit following a cerebral hemorrhage which left her with severe brain damage and ventilator dependent. One year before this event, the patient and her husband had drawn up \"living wills\" with an attorney. She was diagnosed by her treating physician as being in a permanent unconscious condition. The patient\'s living will specified that the patient did not want ventilator support or other artificial life support in the event of a permanent unconscious condition or terminal condition.
The patient\'s husband is her legal next of kin and the person with surrogate decision-making authority. When the living will was discussed with him, he insisted that the patient had not intended for the document to be used in a situation like the present one. Further discussion with him revealed that he understood that the patient would not be able to recover any meaningful brain function but he argued that the living will did not apply because her condition was not imminently terminal. He further indicated that he did not consider his wife to be in a permanent unconscious condition. The immediate family members (the couple’s adult children) disagreed with their father’s refusal to withdraw life support.
The treatment team allowed a week to pass to allow the husband more time to be supported in his grief and to appreciate the gravity of his wife’s situation. Nevertheless, at the end of this time, the husband was unwilling to authorize withdrawal of life support measures consistent with the patient\'s wishes as expressed in her living will. End of scenario.
Your paper should have 3 major sections. Each is numbered 1, 2 and 3. Questions to be discussed based on the facts above. You must weave into your discussion the relevant facts from above scenario to support your discussion in discussion areas 2 and 3 below.And for discussion area 3 you must weave into your discussion the ethics philosophy you pick for each issue from the article A Framework for Thinking Ethically.
Outline: Must use the bolded and underlined headings from the outline below in your paper and the paper must be in narrative form not outline or bullet format. 10% penalty deducted from paper if underlined headings not used in your paper.
There should be three discussion parts to the paper and they are identified as 1, 2, 3 below.
Must use each Bolded headings below in the paper or suffer 10% penalty.
1. Three Legal/Ethical Issues. Just list the three most important legal/ethics issues in this scenario that you will discuss. Pay particular attention to the article I furnished with this assignment. These must be three separate and distinct issues. No explanation needed, just state them a, b and c.
2. Discussion of Three Legal/Ethical Issues. Discuss the three most important ethical/legal issues you listed above. Must use the relevant facts in the scenario to support your discussion of the legal/ethical issues.
Headings will be:
Legal/Ethical issue 1 [state the issue] then discussion
Legal/Ethical issue 2 [state the issue] then discussion
Legal/Ethical issue 3 [state the issue] then discussion
For each legal/ethical issue above discuss
a. Why each is a legal /ethical issue?
b. Discuss each issue in the context of the scenario facts and
c. Define the concepts you use
3. How I would Handle Each Issue. First, in this section and for each issue, as a health care provider, how would you handle each of the three issues discussed above and why? Must use the relevant facts in the scenario to support your positions. Secondly for each issue, using the article in week 1 Discussion 2 entitled \"A Framework of Thinking Ethically\" fully discuss the specific ethics philosophy that would epitomize your handling of each issue. Fully define the specific ethics philosophy used and weave the ethics philosophy into your discussion. See article below entitled A Framework for Thinking Ethically.
Must use each Bolded headings below. Headings will be:
Handling of Legal/ethical issue #1 [then discussion]
Handling of Legal/ethical issue #2 [then discussion]
Handling of Legal/ethical issue #3 [then discussion]
End of paper outline.
This is an independent paper and you are on the honor system not to discuss or consult with any students or other individuals about this paper. Just so you know, all you need to read to support your paper are the two articles I have furnished with this assignment and information in the class.
All you need to read to analyze the questions for this paper are the two articles below entitled:
Clinical Ethics Issues and Discussion and
A Framework for Thinking Ethically
The paper must be:
Paper must be in narrative format not outline or bullets.
Double spaced and be 4-6 pages in 12 point New Times Roman font. [No deduction if paper exceeds a page or so. Thus 3 and half page paper will be penalized.]
Include a cover page [not counted as a page] which should have student name and title of your paper [Provide a short name for the legal responsibility the specific health care organization has for one type of patient right in a specific setting
A the end of the paper a list of references [not counted as a page]
Be prepared using word-processing software and saved with a .doc, .docx, or .rtf extension. No pdf.
Be uploaded to your Assignments Folder by 11:59 p.m. eastern time on the due date.
Late penalties: Paper is due by due date but if there occurs is an extraordinary event beyond your control, then you need to contact me as to the reason and then we can discuss a new due date if I agree with your excuse. In every case of an extension you will be penalized 11% [no chance for an A on the paper] for the first day late and an additional .5 pt. for each day thereafter, no matter the excuse deducted from the 25pts paper is worth.
Footnote example below
In the body of the paper example:(Healthcare Financial Management Association (U.S.), Ernst, & Young, 2000).At the end of the paper example:ReferencesHealthcare Financial Management Association (U.S.), Ernst, & Young. (2000). Health care system reform: A provider perspective : survey results. Westchester, Ill.: Healthcare Financial Management Association.
The paper is to be posted in Assignment #4 drop box.
Grading rubric for assignment is with assignment in Assignments area of class.
Background articles to support the issues you will discuss in the paper.
Article One of Two
Clinical Ethics Issues and Discussion
Relationships: I. clinical ethics, law & risk management
Definitions and sources of authority
In the course of practicing medicine, a range of issues may arise that lead to consultation with a medical ethicist, a lawyer, and/or a risk manager. The following discussion will outline key distinctions between these roles.
Clinical ethics may be defined as: a discipline or methodology for considering the ethical implications of medical technologies, policies, and treatments, with special attention to determining what ought to be done (or not done) in the delivery of health care.
Law may be defined as: established and enforceable social rules for conduct or non-conduct; a violation of a legal standard may create criminal or civil liability.
Risk Management may be defined as: a method of reducing risk of liability through institutional policies/practices.
Many health care facilities have in-house or on-call trained ethicists to assist health care practitioners, caregivers and patients with difficult issues arising in medical care, and some facilities have formally constituted institutional ethics committees. In the hospital setting, this ethics consultation or review process dates back to at least 1992 with the formulation of accreditation requirements that mandated that hospitals establish a “mechanism” to consider clinical ethics issues.
Ethics has been described as beginning where the law ends. The moral conscience is a precursor to the development of legal rules for social order. Ethics and law thus share the goal of creating and maintaining social good and have a symbiotic relationship as expressed in this quote:
[C]onscience is the guardian in the individual of the rules which the community has evolved for its own preservation. William Somerset Maugham
The role of lawyers and risk managers are closely linked in many health care facilities. Indeed, in some hospitals, the administrator with the title of Risk Manager is an attorney with a clinical background. There are, however, important distinctions between law and risk management. Risk management is guided by legal parameters but has a broader institution-specific mission to reduce liability risks. It is not uncommon for a hospital policy to go beyond the minimum requirements set by a legal standard. When legal and risk management issues arise in the delivery of health care, ethics issues may also exist. Similarly, an issue originally identified as falling within the clinical ethics domain may also raise legal and risk management concerns.
To better understand the significant overlap among these disciplines in the health care setting, consider the sources of authority and expression for each.
Ethical norms may be derived from:
Policies of professional organizations
Professional standards of care, fiduciary obligations
Note: If a health care facility is also a religious facility, it may adhere to religious tenets. In general, however, clinical ethics is predominantly a secular professional analytic approach to clinical issues and choices.
Law may be derived from:
Federal and state constitutions (fundamental laws of a nation or state establishing the role of government in relation to the governed)
Federal and state statutes (laws written or enacted by elected officials in legislative bodies, and in some states, such as Washington and California, laws created by a majority of voters through an initiative process)
Federal and state regulations (written by government agencies as permitted by statutory delegation, having the force and effect of law consistent with the enabling legislation)
Federal and state case law (written published opinions of appellate-level courts regarding decisions in individual lawsuits)
City or town ordinances, when relevant
Risk Management may be derived from law, professional standards and individual institution’s mission and public relations strategies and is expressed through institutional policies and practices.
Another way to consider the relationship among the three disciplines is through conceptual models:
Orientation to law for non-lawyers
Potential legal actions against health care providers
There are two primary types of potential civil actions against health care providers for injuries resulting from health care: (1) lack of informed consent, and (2) violation of the standard of care. Medical treatment and malpractice laws are specific to each state.
Informed Consent. Before a health care provider delivers care, ethical and legal standards require that the patient provide informed consent. If the patient cannot provide informed consent, then, for most treatments, a legally authorized surrogate decision-maker may do so. In an emergency situation when the patient is not legally competent to give informed consent and no surrogate decision-maker is readily available, the law implies consent on behalf of the patient, assuming that the patient would consent to treatment if he or she were capable of doing so.
Information that must be conveyed to and consented to by the patient includes: the treatment’s nature and character and anticipated results, alternative treatments (including non-treatment), and the potential risks and benefits of treatment and alternatives. The information must be presented in a form that the patient can comprehend (i.e., in a language and at a level which the patient can understand) and that the consent must be voluntary given. An injured patient may bring an informed consent action against a provider who fails to obtain the patient’s informed consent in accordance with state law.
From a clinical ethics perspective, informed consent is a communication process, and should not simply be treated as a required form for the patient’s signature. Similarly, the legal concept of informed consent refers to a state of mind, i.e., understanding the information provided to make an informed choice. Health care facilities and providers use consent forms to document the communication process. From a provider’s perspective, a signed consent form can be valuable evidence the communication occurred and legal protection in defending against a patient’s claim of a lack of informed consent. Initiatives at the federal level (i.e., the Affordable Care Act) and state level (e.g., Revised Code of Washington § 7.70.060) reflect approaches that support shared decision-making and the use of patient decision aids in order to ensure the provision of complete information for medical decision-making.
Failure to follow standard of care. A patient who is injured during medical treatment may also be able to bring a successful claim against a health care provider if the patient can prove that the injury resulted from the provider’s failure to follow the accepted standard of care. The duty of care generally requires that the provider use reasonably expected knowledge and judgment in the treatment of the patient, and typically would also require the adept use of the facilities at hand and options for treatment. The standard of care emerges from a variety of sources, including professional publications, interactions of professional leaders, presentations and exchanges at professional meetings, and among networks of colleagues. Experts are hired by the litigating parties to assist the court in determining the applicable standard of care.
Many states measure the provider’s actions against a national standard of care (rather than a local one) but with accommodation for practice limitations, such as the reasonable availability of medical facilities, services, equipment and the like. States may also apply different standards to specialists and to general practitioners. As an example of a statutory description of the standard of care, Washington State currently specifies that a health care provider must “exercise that degree of care, skill, and learning expected of a reasonably prudent health care provider at that time in the profession or class to which he belongs, in the State of Washington, acting in the same or similar circumstances.”
III. Common clinical ethics issues: medical decision-making and provider-patient communication
There are a number of common ethical issues that also implicate legal and risk management issues. Briefly discussed below are common issues that concern medical decision-making and provider-patient communication.
If a patient is capable of providing informed consent, then the patient’s choices about treatment, including non-treatment, should be followed. This is an established and enforceable legal standard and also consistent with the ethical principle of respecting the autonomy of the patient. The next two sections (Surrogate decision-making; Advance directives) discuss how this principle is respected from a legal perspective if a patient lacks capacity, temporarily or permanently, to make medical decisions. The third section briefly introduces the issue of provider-patient communication, and highlights a contemporary dilemma raised in decisions regarding the disclosure of medical error to patients.
The determination as to whether a patient has the capacity to provide informed consent is generally a professional judgment made and documented by the treating health care provider. The provider can make a determination of temporary or permanent incapacity, and that determination should be linked to a specific decision. The legal term competency (or incompetency) may be used to describe a judicial determination of decision-making capacity. The designation of a specific surrogate decision-maker may either be authorized by court order or is specified in state statutes.
If a court has determined that a patient is incompetent, a health care provider must obtain informed consent from the court-appointed decision-maker. For example, where a guardian has been appointed by the court in a guardianship action, a health care provider would seek the informed consent of the guardian, provided that the relevant court order covers personal or health care decision-making.
If, however, a physician determines that a patient lacks the capacity to provide informed consent, for example, due to dementia or lack of consciousness, or because the patient is a minor and the minor is legally proscribed from consenting, then a legally authorized surrogate decision-maker may be able to provide consent on the patient’s behalf. Most states have specific laws that delineate, in order of priority, who can be a legally authorized surrogate decision-maker for another person. While these laws may vary, they generally assume that legal relatives are the most appropriate surrogate decision-makers. If, however, a patient has previously, while capable of consenting, selected a person to act as her decision-maker and executed a legal document known as a durable power of attorney for health care or health care proxy, then that designated individual should provide informed consent.
In Washington State, a statute specifies the order of priority of authorized decision-makers as follows: guardian, holder of durable power of attorney; spouse or state registered partner; adult children; parents; and adult brothers and sisters. If the patient is a minor, other consent provisions may apply, such as: court authorization for a person with whom the child is in out-of-home placement; the person(s) that the child’s parent(s) have given a signed authorization to provide consent; or, a competent adult who represents that s/he is a relative responsible for the child’s care and signs a sworn declaration stating so. Health care providers are required to make reasonable efforts to locate a person in the highest possible category to provide informed consent. If there are two or more persons in the same category, e.g., adult children, then the medical treatment decision must be unanimous among those persons. A surrogate decision-maker is required to make the choice she believes the patient would have wanted, which may not be the choice the decision-maker would have chosen for herself in the same circumstance. This decision-making standard is known as substituted judgment. If the surrogate is unable to ascertain what the patient would have wanted, then the surrogate may consent to medical treatment or non-treatment based on what is in the patient\'s best interest.
Laws on surrogate decision-making are slowly catching up with social changes. Non-married couples (whether heterosexual or same sex) have not traditionally been recognized in state law as legally authorized surrogate decision-makers. This lack of recognition has left providers in a difficult legal position, encouraging them to defer to the decision-making of a distant relative over a spouse-equivalent unless the relative concurs. Washington law, for example, now recognizes spouses and domestic partners registered with the state as having the same priority status.
Parental decision-making and minor children. A parent may not be permitted in certain situations to consent to non-treatment of his or her minor child, particularly where the decision would significantly impact and perhaps result in death if the minor child did not receive treatment. Examples include parents who refuse medical treatment on behalf of their minor children because of the parents’ social or religious views, such as Jehovah’s Witnesses and Christian Scientists. The decision-making standard that generally applies to minor patients in such cases is known as the best interest standard. The substituted judgment standard may not apply because the minor patient never had decision-making capacity and therefore substituted judgment based on the minor’s informed choices is not able to be determined. It is important to note that minors may have greater authority to direct their own care depending on their age, maturity, nature of medical treatment or non-treatment, and may have authority to consent to specific types of treatment. For example, in Washington State, a minor may provide his or her own informed consent for treatment of mental health conditions, sexually transmitted diseases, and birth control, among others. Depending on the specific facts, a health care provider working with the provider’s institutional representatives could potentially legally provide treatment of a minor under implied consent for emergency with documentation of that determination, assume temporary protective custody of the child under child neglect laws, or if the situation is non-urgent, the provider could seek a court order to authorize treatment.
The term advance directive refers to several different types of legal documents that may be used by a patient while competent to record future wishes in the event the patient lacks decision-making capacity. The choice and meaning of specific advance directive terminology is dependent on state law. Generally, a living will expresses a person’s desires concerning medical treatment in the event of incapacity due to terminal illness or permanent unconsciousness. A durable power of attorney for health care or health care proxy appoints a legal decision- maker for health care decisions in the event of incapacity. An advance health care directive or health care directive may combine the functions of a living will and durable power of attorney for health care into one document in one state, but may be equivalent to a living will in another state. The Physician Orders for Life Sustaining Treatment (POLST) form is a document that is signed by a physician and patient which summarizes the patient’s wishes concerning medical treatment at the end of life, such as resuscitation, antibiotics, other medical interventions and artificial feeding, and translates them into medical orders that follow patients regardless of care setting. It is especially helpful in effectuating a patient’s wishes outside the hospital setting, for example, in a nursing care facility or emergency medical response context. This relatively new approach is available in about a dozen states, although the programs may operate under different names: POST (Physician Orders for Scope of Treatment), MOST (Medical Orders for Scope of Treatment), MOLST (Medical Orders for Life-Sustaining Treatment), and COLST (Clinician Orders for Life-Sustaining Treatment). The simple one page treatment orders follow patients regardless of care setting. Thus it differs from an advance directive because it is written up by the clinician in consultation with the patient and is a portable, actionable medical order. The POLST form is intended to complement other forms of advance directives. For example, Washington State recognizes the following types of advance directives: the health care directive (living will), the durable power of attorney for health care, and the POLST form. Washington also recognizes another legal document known as a mental health advance directive, which can be prepared by individuals with mental illness who fluctuate between capacity and incapacity for use during times when they are incapacitated.
State laws may also differ on the conditions that can be covered by an individual in an advance directive, the procedural requirements to ensure that the document is effective (such as the number of required witnesses) and the conditions under which it can be implemented (such as invalidity during pregnancy).
Advance directives can be very helpful in choosing appropriate treatment based upon the patient’s expressed wishes. There are situations, however, in which the advance directive’s veracity is questioned or in which a legally authorized surrogate believes the advance directive does not apply to the particular care decision at issue. Such conflicts implicate clinical ethics, law and risk management.
Provider-patient communications: disclosing medical error
Honest communication to patients by health care providers is an ethical imperative. Excellent communication eliminates or reduces the likelihood of misunderstandings and conflict in the health care setting, and also may affect the likelihood that a patient will sue.
One of the more contentious issues that has arisen in the context of communication is whether providers should disclose medical errors to patients, and if so, how and when to do so. Disclosure of medical error creates a potential conflict among clinical ethics, law and risk management. Despite a professional ethical commitment to honest communication, providers cite a fear of litigation as a reason for non-disclosure. Specifically, the fear is that those statements will stimulate malpractice lawsuits or otherwise be used in support of a claim against the provider. An increase in malpractice claims could then negatively affect the provider’s claims history and malpractice insurance coverage.
There is some evidence in closed systems (one institution, one state with one malpractice insurer) that an apology coupled with disclosure and prompt payment may decrease either the likelihood or amount of legal claim. In addition, a number of state legislatures have recently acted to protect provider apologies, or provider apologies coupled with disclosures, from being used by a patient as evidence of a provider’s liability in any ensuing malpractice litigation. It is currently too early to know whether these legal protections will have any impact on the size or frequency of medical malpractice claims. For this reason and others, it is advisable to involve risk management and legal counsel in decision-making regarding error disclosure.
Article Two of Two
A Framework for Thinking Ethically
This document is designed as an introduction to thinking ethically. We all have an image of our better selves-of how we are when we act ethically or are \"at our best.\" We probably also have an image of what an ethical community, an ethical business, an ethical government, or an ethical society should be. Ethics really has to do with all these levels-acting ethically as individuals, creating ethical organizations and governments, and making our society as a whole ethical in the way it treats everyone.
What is Ethics?
Simply stated, ethics refers to standards of behavior that tell us how human beings ought to act in the many situations in which they find themselves-as friends, parents, children, citizens, businesspeople, teachers, professionals, and so on.
It is helpful to identify what ethics is NOT:
• Ethics is not the same as feelings. Feelings provide important information for our ethical choices. Some people have highly developed habits that make them feel bad when they do something wrong, but many people feel good even though they are doing something wrong. And often our feelings will tell us it is uncomfortable to do the right thing if it is hard.
• Ethics is not religion. Many people are not religious, but ethics applies to everyone. Most religions do advocate high ethical standards but sometimes do not address all the types of problems we face.
• Ethics is not following the law. A good system of law does incorporate many ethical standards, but law can deviate from what is ethical. Law can become ethically corrupt, as some totalitarian regimes have made it. Law can be a function of power alone and designed to serve the interests of narrow groups. Law may have a difficult time designing or enforcing standards in some important areas, and may be slow to address new problems.
• Ethics is not following culturally accepted norms. Some cultures are quite ethical, but others become corrupt -or blind to certain ethical concerns (as the United States was to slavery before the Civil War). \"When in Rome, do as the Romans do\" is not a satisfactory ethical standard.
• Ethics is not science. Social and natural science can provide important data to help us make better ethical choices. But science alone does not tell us what we ought to do. Science may provide an explanation for what humans are like. But ethics provides reasons for how humans ought to act. And just because something is scientifically or technologically possible, it may not be ethical to do it.
Why Identifying Ethical Standards is Hard
There are two fundamental problems in identifying the ethical standards we are to follow:
1. On what do we base our ethical standards?
2. How do those standards get applied to specific situations we face?
If our ethics are not based on feelings, religion, law, accepted social practice, or science, what are they based on? Many philosophers and ethicists have helped us answer this critical question. They have suggested at least five different sources of ethical standards we should use.
Five Sources of Ethical Standards
The Utilitarian Approach
Some ethicists emphasize that the ethical action is the one that provides the most good or does the least harm, or, to put it another way, produces the greatest balance of good over harm. The ethical corporate action, then, is the one that produces the greatest good and does the least harm for all who are affected-customers, employees, shareholders, the community, and the environment. Ethical warfare balances the good achieved in ending terrorism with the harm done to all parties through death, injuries, and destruction. The utilitarian approach deals with consequences; it tries both to increase the good done and to reduce the harm done.
The Rights Approach
Other philosophers and ethicists suggest that the ethical action is the one that best protects and respects the moral rights of those affected. This approach starts from the belief that humans have a dignity based on their human nature per se or on their ability to choose freely what they do with their lives. On the basis of such dignity, they have a right to be treated as ends and not merely as means to other ends. The list of moral rights -including the rights to make one\'s own choices about what kind of life to lead, to be told the truth, not to be injured, to a degree of privacy, and so on-is widely debated; some now argue that non-humans have rights, too. Also, it is often said that rights imply duties-in particular, the duty to respect others\' rights.
The Fairness or Justice Approach
Aristotle and other Greek philosophers have contributed the idea that all equals should be treated equally. Today we use this idea to say that ethical actions treat all human beings equally-or if unequally, then fairly based on some standard that is defensible. We pay people more based on their harder work or the greater amount that they contribute to an organization, and say that is fair. But there is a debate over CEO salaries that are hundreds of times larger than the pay of others; many ask whether the huge disparity is based on a defensible standard or whether it is the result of an imbalance of power and hence is unfair.
The Common Good Approach
The Greek philosophers have also contributed the notion that life in community is a good in itself and our actions should contribute to that life. This approach suggests that the interlocking relationships of society are the basis of ethical reasoning and that respect and compassion for all others-especially the vulnerable-are requirements of such reasoning. This approach also calls attention to the common conditions that are important to the welfare of everyone. This may be a system of laws, effective police and fire departments, health care, a public educational system, or even public recreational areas.
The Virtue Approach
A very ancient approach to ethics is that ethical actions ought to be consistent with certain ideal virtues that provide for the full development of our humanity. These virtues are dispositions and habits that enable us to act according to the highest potential of our character and on behalf of values like truth and beauty. Honesty, courage, compassion, generosity, tolerance, love, fidelity, integrity, fairness, self-control, and prudence are all examples of virtues. Virtue ethics asks of any action, \"What kind of person will I become if I do this?\" or \"Is this action consistent with my acting at my best?\"
Putting the Approaches Together
Each of the approaches helps us determine what standards of behavior can be considered ethical. There are still problems to be solved, however.
The first problem is that we may not agree on the content of some of these specific approaches. We may not all agree to the same set of human and civil rights.
We may not agree on what constitutes the common good. We may not even agree on what is a good and what is a harm.
The second problem is that the different approaches may not all answer the question \"What is ethical?\" in the same way. Nonetheless, each approach gives us important information with which to determine what is ethical in a particular circumstance. And much more often than not, the different approaches do lead to similar answers.
Making good ethical decisions requires a trained sensitivity to ethical issues and a practiced method for exploring the ethical aspects of a decision and weighing the considerations that should impact our choice of a course of action. Having a method for ethical decision making is absolutely essential. When practiced regularly, the method becomes so familiar that we work through it automatically without consulting the specific steps.
The more novel and difficult the ethical choice we face, the more we need to rely on discussion and dialogue with others about the dilemma. Only by careful exploration of the problem, aided by the insights and different perspectives of others, can we make good ethical choices in such situations.
We have found the following framework for ethical decision making a useful method for exploring ethical dilemmas and identifying ethical courses of action.
A Framework for Ethical Decision Making
Recognize an Ethical Issue
Could this decision or situation be damaging to someone or to some group? Does this decision involve a choice between a good and bad alternative, or perhaps between two \"goods\" or between two \"bads\"?
Is this issue about more than what is legal or what is most efficient? If so, how?
Get the Facts
What are the relevant facts of the case? What facts are not known? Can I learn more about the situation? Do I know enough to make a decision?
What individuals and groups have an important stake in the outcome? Are some concerns more important? Why?
What are the options for acting? Have all the relevant persons and groups been consulted? Have I identified creative options?
Evaluate Alternative Actions
Evaluate the options by asking the following questions:
Which option will produce the most good and do the least harm? (The Utilitarian Approach)
Which option best respects the rights of all who have a stake? (The Rights Approach)
Which option treats people equally or proportionately? (The Justice Approach)
Which option best serves the community as a whole, not just some members? (The Common Good Approach)
Which option leads me to act as the sort of person I want to be? (The Virtue Approach)
Make a Decision and Test It
Considering all these approaches, which option best addresses the situation?
If I told someone I respect-or told a television audience-which option I have chosen, what would they say?
Act and Reflect on the Outcome
How can my decision be implemented with the greatest care and attention to the concerns of all stakeholders?
How did my decision turn out and what have I learned from this specific situation?
This framework for thinking ethically is the product of dialogue and debate at the Markkula Center for Applied Ethics at Santa Clara University. Primary contributors include Manuel Velasquez, Dennis Moberg, Michael J. Meyer, Thomas Shanks, Margaret R. McLean, David DeCosse, Claire André, and Kirk O. Hanson. It was last revised in May 2009. End of article
⭐ [ULTIMATE EXAM SUMMARY] MITCH - Management of Innovative Technologies in Community Based Health Care (2018/2019) ⭐
This is a complete summary document of all lectures and required literature articles needed for the exam of "Management of Innovative Technologies in Community Based Health Care (MITCH)".
Academic year of 2018 / 2019
NURSING NUR 3065 Physical Assessment in Health Care- Quiz 6. Graded A
NURSING NUR 3065 Physical Assessment in Health Care- Quiz 6 • Question 1 2.5 out of 2.5 points You are performing a physical examination on a 46-year-old male patient. His examinati on findings include the following: positive peripheral edema, holosystolic murmur in the tricuspid region, and a pulsatile liver. His diagnosis is: • Question 2 2.5 out of 2.5 points You are performing jugular venous pressure measurement for your patient in heart failure. You see a pulse wave with the patient’s head elevated at a 45-degree angle. Your action as a result of this assessment is to: • Question 3 2.5 out of 2.5 points Which of the following statements is true regarding the development of venous ulcers in older adults? b. Diabetes, peripheral neuropathy, and nutritional deficiencies are causative factors. • Question 4 2.5 out of 2.5 points Which arterial pulse is most useful for evaluating heart activity? • Question 5 2.5 out of 2.5 points You are examining Mr. S, a 79-year-old diabetic man complaining of claudication. Which of the following physical findings is consistent with the diagnosis of peripheral arterial disease? • Question 6 2.5 out of 2.5 points Which of the following statements is true regarding the examination of peripheral arteries? • Question 7 2.5 out of 2.5 points You are palpating bilateral pedal pulses and cannot feel one of the pulses. The feet are equally warm. You find that both great toes are pink, with a capillary refill within 2 seconds. Which of the following statements is correct? • Question 8 2.5 out of 2.5 points Which of the following are risk factors for varicose veins? (Select all that apply.) • Question 9 2.5 out of 2.5 points You are assessing Mr. Z’s fluid volume status as a result of heart failure. If your finger depresses a patient’s edematous ankle to a depth of 6 mm, you should record this pitting as: • Question 10 2.5 out of 2.5 points Which of the following statements is most accurate in describing hepatojugular reflux? • Question 11 2.5 out of 2.5 points Which of the following arteries provides blood supply to the breast? • Question 12 2.5 out of 2.5 points Which of the following muscles form the floor of the breast? (Select all that apply.) • Question 13 2.5 out of 2.5 points You are conducting a clinical breast examination for your 30-year-old patient. Her breasts are symmetric, with bilateral, multiple tender masses that are freely moveable and with well-defined borders. You recognize that these symptoms and assessment findings are consistent with: • Question 14 2.5 out of 2.5 points Which finding, on inspection, is related to fibrotic tissue changes that occur with breast carcinoma? • Question 15 2.5 out of 2.5 points Which of the following is a common benign variation in the breasts of a pregnant woman? • Question 16 2.5 out of 2.5 points You are performing a clinical breast examination for a 55-year-old woman. While palpating the supraclavicular area, you suspect that you feel a node. To improve your hooked technique, you should: • Question 17 2.5 out of 2.5 points While examining a 30-year-old woman, you note that one breast is slightly larger than the other. In response to this finding, you should: • Question 18 2.5 out of 2.5 points While collecting personal and social history data from a woman complaining of breast discomfort, you should question her regarding her: • Question 19 2.5 out of 2.5 points Your patient is a nursing mother who asks you to look at a mole she has under her left breast at the inframammary fold. The mole is nontender and soft and has grown in size since she started nursing. There are no other changes to the mole. This mole probably represents an undiagnosed: • Question 20 2.5 out of 2.5 points Which of the following is most likely to be a variation of minor consequence? • Question 21 2.5 out of 2.5 points Which of the following is true regarding the stomach? • Question 22 0 out of 2.5 points You are examining the abdomen of a 45-year-old female patient. When percussing her urine-filled bladder, you will hear _______________ tones. • Question 23 2.5 out of 2.5 points Your patient returns to the office with multiple complaints regarding her abdomen. Which of the following are objective findings? (Select all that apply.) • Question 24 2.5 out of 2.5 points Your patient is a 48-year-old woman with complaints of severe cramping pain in the abdomen and right flank. Her past medical history includes a history of bladder calculi. You diagnose her with renal calculi at this time. Which of the following symptoms would you expect with her diagnosis? (Select all that apply.) • Question 25 0 out of 2.5 points You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient: • Question 26 2.5 out of 2.5 points Which structure is located in the hypogastric region of the abdomen? • Question 27 2.5 out of 2.5 points Which organs have both an excretion function and function as endocrine glands? • Question 28 2.5 out of 2.5 points Which of the following organs is part of the alimentary tract? • Question 29 2.5 out of 2.5 points Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition? • Question 30 2.5 out of 2.5 points Your patient is complaining of acute, intense, sharp epigastric pain that radiates to the back and left scapula, with nausea and vomiting. Based on this history, your prioritized physical examination should be to: • Question 31 2.5 out of 2.5 points Which of the following information belongs in the past medical history section related to heart and blood vessel assessment? • Question 32 2.5 out of 2.5 points Your patient, who abuses intravenous (IV) drugs, has a sudden onset of fever and symptoms of congestive heart failure. Inspection of the skin reveals nontender erythematic lesions to the palms. These findings are consistent with the development of: • Question 33 2.5 out of 2.5 points You are conducting an examination of Mr. Curtis’s heart and blood vessels and auscultate a grade III murmur. The intensity of this murmur is: • Question 34 2.5 out of 2.5 points Which two structures together form the primary muscle mass of the heart? • Question 35 2.5 out of 2.5 points Which one of the following is a common symptom of cardiovascular disorders in the older adult? • Question 36 0 out of 2.5 points Your patient has been diagnosed with pericarditis. Which of the following are signs and symptoms, or a precipitating factor?(Select all that apply.) • Question 37 2.5 out of 2.5 points Which cardiac structure is responsible for the heart’s pumping action? • Question 38 2.5 out of 2.5 points Which dysrhythmia is a physiologic event during childhood? • Question 39 2.5 out of 2.5 points You are listening to a patient’s heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound in this area is most likely: • Question 40 2.5 out of 2.5 points Which two heart chambers are most anterior in the chest?
FNU Physical Assessment in Health Care Final exam
Cerebrospinal fluid serves as a:
a. to regulate the chemical environment of the nervous tissue
b. to rinse metabolic wastes from the nervous tissue
c. to provide oxygen and nutrients to the nervous tissue
d. to protect the brain from striking the cranium when the head is jolted
At what age should the infant begin to transfer objects from hand to hand?
a. 2 months
b. 4 months
c. 7 months
d. 10 months
Deep pressure tests are used mostly for patients who are experiencing:
a. absent superficial pain sensation.
b. gait and stepping disturbances.
c. lordosis, osteoporosis, or arthritis.
d. brisk reflexes.
As Mr. B enters the room, you observe that his gait is wide-based and he staggers from side to side while swaying his trunk. You would document Mr. B’s pattern as:
a. dystonic ataxia.
b. cerebellar ataxia.
c. steppage gait.
d. tabetic stamping.
Cranial nerve XII may be assessed in an infant by:
a. watching the infant's facial expressions when crying.
b. observing the infant suck and swallow.
c. clapping hands and watching the infant blink.
d. observing the infant's rooting reflex.
If a patient cannot shrug his or her shoulders against resistance, which cranial nerve (CN) requires further evaluation?
a. CN I, olfactory
b. CN V, trigeminal
c. CN IX, glossopharyngeal
d. CN XI, spinal accessory
Ipsilateral Horner syndrome indicates a cerebrovascular accident (CVA) occurring in the:
a. anterior spinal artery.
b. internal or middle cerebral artery.
c. posterior inferior cerebellar artery.
d. vertebral or basilar arteries.
A neurologic past medical history should include data about:
a. family patterns of dexterity and dominance.
b. circulatory problems.
c. educational level.
An acute polyneuropathy that commonly follows a nonspecific infection occurring 10 to 14 days earlier and that primarily affects the motor and autonomic peripheral nerves in an ascending pattern is:
a. cerebral palsy.
b. HIV encephalopathy.
c. GuillainBarré syndrome.
d. Rett syndrome.
Diabetic peripheral neuropathy will likely produce:
a. hyperactive ankle reflexes.
b. diminished pain sensation.
c. exaggerated vibratory sense.
d. hypersensitive temperature perception.
A major risk factor for arterial embolic disease is:
a. venous thrombosis.
b. atrial fibrillation.
d. diuretic therapy.
An idiopathic spasm of arterioles in the digits is termed:
a. arteriosclerosis obliterans.
b. giant cell arteritis.
c. arteriovenous fistula.
d. Raynaud disease.
Conduction system impairment should be suspected if an irregular heartbeat is:
If pitting edema is unilateral, you would suspect occlusion of a:
a. lymphatic duct.
b. major vein.
c. surface capillary.
d. superficial artery.
A characteristic distinguishing primary Raynaud phenomenon from secondary Raynaud phenomenon includes which of the following?
b. Digital ischemia with pain.
c. Triphasic demarcated skin.
d. Cold and achy improving with warming.
A venous hum heard over the internal jugular vein of a child:
a. usually signifies untreatable illness.
b. usually has no pathologic significance.
c. usually requires surgical intervention.
d. must be monitored until the child is grown.
A bounding pulse in an infant may be associated with:
a. patent ductus arteriosus.
b. coarctation of the aorta.
c. decreased cardiac output.
d. peripheral vaso-occlusion.
A pulsation that is diminished to the point of being barely palpable would be graded as:
During a routine prenatal visit, Ms. T was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings:
a. are usual conditions during pregnancy.
b. indicate a need for hospitalization.
c. indicate the need for amniocentesis.
d. suggest that she is having twins.
A sound similar to a murmur that is heard over arteries is a:
c. friction rub.
A firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-year-old patient’s breast. You should:
a. ask the patient if she has a history of breast cancer.
b. refer the patient to a surgeon.
c. ask the patient to have a mammogram as soon as possible.
d. record the finding in the patient's record.
A 23-year-old white woman has come to the clinic because she has missed two menstrual periods. She states that her breasts have enlarged and that her nipples have turned a darker color. Your response to this finding is to:
a. instruct her that this is a side effect of birth control injection therapy.
b. suggest pregnancy testing.
c. question her use of tanning beds.
d. schedule an appointment with a surgeon.
If your patient has nipple discharge, you will most likely need a:
a. Vacutainer tube.
b. glass slide and fixative.
c. specimen jar with formaldehyde.
d. tape strip to test pH.
A peppering of nontender, nonsuppurative Montgomery tubercles is considered to be a:
a. normal finding.
b. sign of carcinoma.
c. skin disease.
d. symptom of malnutrition.
Contraction of breast smooth muscle results in:
a. benign breast lumps.
b. the emptying of milk ducts.
c. nipple inversion.
d. nipple tenderness.
Documentation of a breast mass location is done:
a. according to illustration, without a narra-tive.
b. according to clock positions from the nip-ple.
c. by measuring with calipers from the nip-ple.
d. by measuring in centimeters from the sternal notch.
During pregnancy, which of the following changes normally occurs in the breasts because of the effects of luteal and placental hormones?
a. The amount of connective tissue increases.
b. The epithelial secretory activity decreases.
c. The alveoli increase in size and number.
d. Vascularization decreases.
A 50-year-old woman presents as a new patient. Which finding in her personal and social history would increase her risk profile for developing breast cancer?
a. Drinking three glasses of wine per week
b. Early menopause
d. Late menarche
A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythemic breasts bilaterally. You should advise the patient to:
a. massage gently and continue nursing.
b. apply warm compresses and stop nursing.
c. monitor her temperature and restrict flu-ids.
d. sleep wearing a bra and wash her breasts with antibacterial soap.
For purposes of examination and communication of physical findings, the breast is divided into:
a. halves (upper and lower).
b. thirds (left, middle, and right).
c. four quadrants plus a tail.
d. circles (six consecutive rings, each 1 inch farther away from nipple).
Equipment for examination of the anus, rectum, and prostate routinely includes gloves and:
a. a hand mirror and gauze.
b. a lubricant and penlight.
c. slides and normal saline.
d. swabs and culture medium.
A healthy prostate protrudes into the rectal wall a distance of _____ cm.
a. less than 1
b. 1 to 2
c. 2 to 3
d. 3 to 4
A common cause of dark green or black stools during pregnancy is:
a. consumption of iron preparations.
b. consumption of vitamins.
c. slow intestinal bleeding.
d. slow bleeding of hemorrhoids.
In males, which surface of the prostate gland is accessible by digital examination?
a. Median lobe
Baby Sue is born with an imperforate anus. However, her outward anal appearance is normal. Which sign would indicate to the health care provider that she has a closed anal passageway?
a. Development of a scaphoid abdomen
b. Vomiting after her first feeding
c. Bleeding from the rectum
d. Failure to pass meconium stool
A 70-year-old man has a prostate-specific antigen (PSA) value of 6 ng/mL and a negative digital rectal examination (DRE). These results indicate:
a. prostatic hypertrophy.
b. prostate cancer.
c. internal hemorrhoids.
d. a normal finding.
An infant with constipation and a consistently empty rectum may need evaluation for:
a. sexual abuse.
b. Hirschsprung disease.
c. rectal abscess.
d. intestinal parasites.
An expected anal or rectal finding late in pregnancy is the presence of:
A lower spinal cord lesion may be indicated by which finding?
a. Lack of an anal wink
b. Rectal prolapse
c. Anal fistula
d. Small flaps of anal skin
Factors associated with increased risk of prostate cancer include:
a. African descent.
b. cigarette smoking.
c. a low-fat diet.
Bimanual examination of the uterus includes:
a. grasping the cervix between the examining fingers.
b. grasping the vaginal wall and pulling it downward.
c. inserting one finger into the fundus.
d. placing the thumb on the clitoris and the forefinger on the cervix.
A young, sexually active woman comes to the urgent care clinic complaining of suprapubic abdominal pain. She is afebrile with rebound tenderness to the right side. There is no dysuria and no vaginal discharge or odor. A pelvic examination is done. She has pain with cervical motion, and you palpate a painful mass over the left adnexal area. Your prioritized action is to:
a. swab for gonococcal infection and then dip her urine.
b. obtain a surgical consult immediately.
c. remove the foreign body.
d. dip her urine and then swab for Chlamy-dia.
A 3-year-old girl is being seen because of a foul vaginal odor. To inspect the vaginal vault, you should first:
a. insert a pediatric vaginal speculum.
b. place the child prone and in the fetal posi-tion.
c. insert a cotton-tipped applicator and press down.
d. pull the labia forward and slightly to the side.
Asking the woman to close the introitus during a pelvic examination is a test for:
c. cervical polyps.
d. sphincter tone.
A cervical polyp usually appears as a:
a. grainy area at the ectocervical junction.
b. bright red, soft protrusion from the endo-cervical canal.
c. transverse or stellate scar.
d. hard granular surface at or near the os.
A bluish color to the cervix during pregnancy is called (the):
a. McDonald sign.
c. Goodell sign.
d. Chadwick sign.
Dacron swabs are necessary when testing for which condition?
A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. On inspection, you find posterior vulvar and gross perineum bruising.These findings are consistent with:
a. chronic masturbation.
b. congenital defects.
c. acute urinary tract infection.
d. sexual abuse.
A fixed uterus may indicate ______________.
An examiner has rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection?
a. Gonococcal cultureb
b. Cytology smear
c. Haemophilus smear
d. Trichomonas smear
A third heart sound is created by:
a. atrial contraction.
b. ventricular contraction.
c. diastolic filling.
d. regurgitation between the right and left ventricles.
A grade IV mitral regurgitation murmur would:
a. be described as a diastolic murmur.
b. not be expected to have a thrill.
c. radiate to the axilla.
d. be heard best at the base.
An example of a functional heart murmur is one that is caused by:
b. a ventricular septal defect.
c. an atrial septal defect.
d. mitral valve prolapse.
A lift along the left sternal border is most likely the result of:
a. aortic stenosis.
b. atrial septal defect.
c. pulmonary hypertension.
d. right ventricular hypertrophy.
A grade I or II murmur, without radiation and of medium pitch, is a common variation found in:
a. school-age children.
b. older women.
c. middle-age men.
d. older adults.
A condition that is likely to present with dizziness and syncope is:
a. bacterial endocarditis.
c. sick sinus syndrome.
An apical PMI palpated beyond the fifth intercostal space may indicate:
a. decreased cardiac output.
c. left ventricular hypertrophy.
A patient you are seeing in the emergency department for chest pain is believed to be having a myocardial infarction. During the health history interview of his family history, he relates that his father had died of“heart trouble.” The most important follow-up question you should pose is which of the following?
a. "Did your father have coronary bypass surgery?"
b. "Did your father's father have heart trouble also?"
c. "What were your father's usual dietary habits?"
d. "What age was your father at the time of his death?"
A split second heart sound is:
b. greatest at the peak of inspiration.
c. heard best after forceful expiration.
d. supposed to disappear with deep inspira-tion.
A palpable rushing vibration over the base of the heart at the second intercostal space is called a:
Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his right upper quadrant. Joe’s lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe’s symptoms?
b. Kidney stones
c. Meconium ileus
d. Pyloric stenosis
A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:
a. use a topical, over the counter hemorrhoid treatment for 1 week.
b. exercise and eat more fiber.
c. come to the laboratory for a stool guaiac test.
d. eat six small meals a day.
A 23-year-old man comes to the urgent care clinic with intense left flank and lower left quadrant pain. A patient response to a history of present illness questions that further supports a tentative diagnosis of renal calculi is which of the following?
a. use a topical, over the counter hemorrhoid treatment for 1 week.
b. exercise and eat more fiber.
c. come to the laboratory for a stool guaiac test.
d. eat six small meals a day.
A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she fastens the child’s diaper. Nephroblastoma is a likely diagnosis for this child when your physical examination of the abdomen reveals a(n):
a. fixed mass palpated in the hypogastric area.
b. tender, midline abdominal mass.
c. olive-sized mass of the right upper qua-drant.
d. nontender, slightly movable, flank mass.
An umbilical assessment in the newborn that is of concern is:
a. a thick cord.
b. umbilical hernia.
c. one umbilical artery and two veins.
d. pulsations superior to the umbilicus.
Before performing an abdominal examination, the examiner should:
a. ascertain the patient's HIV status.
b. have the patient empty his or her bladder.
c. don double gloves.
d. completely disrobe the patient.
A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the:
Contraction of the gallbladder propels bile into the:
d. large intestine.
A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. Which organ is most likely injured?
After thorough inspection of the abdomen, the next assessment step is:
d. rectal examination.
A 12-year-old boy relates that his left scrotum has a soft swollen mass. The scrotum is not painful on palpation. The left inguinal canal is without masses. The mass transilluminates with a penlight. This collection of symptoms is consistent with:
b. a hydrocele.
c. a rectocele.
d. a scrotal hernia.
Expected genitalia changes that occur as men age include that:
a. the ejaculatory volume decreases with age.
b. erections develop more quickly.
c. the viability of sperm increases.
d. the scrotum becomes more pendulous.
A premature infant’s scrotum will appear:
A painless indurated lesion on the glans penis is most consistent with a _________.
Difficulty replacing the retracted foreskin of the penis to its normal position is called:
b. Peyronie disease.
An enlarged painless testicle in an adolescent or adult male may indicate:
b. testicular torsion.
c. a tumor.
d. an undescended testicle.
An adolescent male is being seen for acute onset of left testicular pain. The pain started 3 hours ago. He complains of nausea and denies dysuria or fever. Your priority action should be to:
a. obtain urine and DNA probe urethral samples.
b. lift the left scrotum to confirm epididymi-tis.
c. establish absent cremasteric reflex.
d. transilluminate the left and right scrotum.
A characteristic related to syphilis or diabetic neuropathy is testicular:
a. dropping, with asymmetry.
c. insensitivity to painful stimulation.
d. recession into the abdomen.
A cremasteric reflex should result in:
a. testicular and scrotal rise on the stroked side.
b. penile deviation to the left side.
c. bilateral elevation of the scrotum.
d. immediate erection of the penis.
A finding associated with recurrent male genital herpes is:
a. disseminated lymphadenopathy.
b. pain subsiding with scrotal elevation.
c. soft, red papules on the prepuce.
d. superficial penile vesicles.
A 3-year-old is brought to the clinic complaining of a painful right elbow. He is holding his right arm slightly flexed and pronated and refuses to move it. The mother states that symptoms started right after his older brother had been swinging him around by his arms. This presentation supports a diagnosis of:
a. radial head subluxation.
b. femoral anteversion.
c. carpal tunnel syndrome.
A common finding in markedly obese patients and pregnant women is:
A tingling sensation radiating from the wrist to the hand on striking the median nerve is a positive _____ sign.
A finding that is indicative of osteoarthritis is (are):
a. swan neck deformities.
b. Bouchard nodes.
d. Heberden nodes.
A red, hot, swollen joint in a 40-year-old man should lead you to suspect:
A dowager hump is:
A positive straight leg raise test usually indicates:
a. leg length discrepancy.
b. improperly conditioned muscles.
c. lumbar nerve root irritation.
d. hip bursitis.
A wheelchair-dependent older woman would most likely develop skin breakdown at:
b. the iliac crests.
d. the gibbus.
A goniometer is used to assess:
a. bone maturity.
b. joint proportions.
c. range of motion.
d. muscle strength.
A 7-year-old child who begins to limp and complains of persistent hip pain may have:
a. congenital hip dislocation.
b. Dupuytren contracture.
c. Legg-Calvé-Perthes disease.
Functional assessment is most important during the examination of a(n):
c. older adult.
d. young adult.
An ophthalmoscopic eye examination involves:
a. lens inspection.
b. near vision evaluation.
c. sclera observation.
d. visual field assessment.
For a routine physical examination, all the following equipment is necessary except:
a. a penlight.
b. a measuring tape.
c. examination gloves.
d. a monofilament.
A common method for estimating gestational age of a newborn is to assess:
a. middle finger length.
b. creases on the sole of the foot.
c. umbilical placement.
d. visual acuity.
Examination of the patient in the lithotomy, or knee-chest, position includes:
a. inspection for inguinal hernias.
b. palpation of anal sphincter tone.
c. percussion of pelvic structures.
d. stereognosis testing.
According to the usual examination procedure, you would first assist your patient to assume which position?
An examiner might be able to help a patient who seems uncomfortable with close contact during an examination by:
a. acknowledging the discomfort.
b. backing away from the patient.
c. joking about the patient's discomfort.
d. moving briskly to completion.
At your first meeting with a patient, it is usually best to say:
a. "Let's get to the point.".
b. "I hope you will learn to trust me.".
c. "Let me tell you what I can do for you.".
d. "Tell me about yourself.".
As you greet the patient, which examination technique is first implemented?
In crying infants, it is often difficult to:
a. perform tactile fremitus assessments.
b. determine lung expansion.
c. auscultate heart sounds.
d. visualize the pharynx.
UNIT 10 SOCIOLOGICAL PERSPECTIVES ASSIGNMENT 2
A report on the sociological explanations for patterns and trends of health and ill health in different social groups. This should include how demographic data is used in service provision in a local health and social care setting to reduce social inequality affecting those groups.
NURS 4105 Advocacy Through Health Care Policy Final Exam - Walden University.pdf
NURS 4105 Advocacy Through Health Care Policy Final Exam - Walden U
Physical Assessment in Health Care-DL-F Angel Cano graded A
• Question 1
2.5 out of 2.5 points
You are performing a physical examination on a 46-year-old male patient. His examination findings include the following: positive peripheral edema, holosystolic murmur in the tricuspid region, and a pulsatile liver. His diagnosis is:
Selected Answer: a.
• Question 2
2.5 out of 2.5 points
You are performing jugular venous pressure measurement for your patient in heart failure. You see a pulse wave with the patient’s head elevated at a 45-degree angle. Your action as a result of this assessment is to:
Selected Answer: b.
confirm that the pulsations decrease with inspirations.
• Question 3
2.5 out of 2.5 points
Which of the following statements is true regarding the development of venous ulcers in older adults?
Selected Answer: b.
Diabetes, peripheral neuropathy, and nutritional deficiencies are causative factors.
• Question 4
2.5 out of 2.5 points
Which arterial pulse is most useful for evaluating heart activity?
Selected Answer: a.
• Question 5
2.5 out of 2.5 points
You are examining Mr. S, a 79-year-old diabetic man complaining of claudication. Which of the following physical findings is consistent with the diagnosis of peripheral arterial disease?
Selected Answer: b.
Loss of hair over the extremities
• Question 6
2.5 out of 2.5 points
Which of the following statements is true regarding the examination of peripheral arteries?
Selected Answer: c.
The pulses are most readily felt over bony prominences.
• Question 7
2.5 out of 2.5 points
You are palpating bilateral pedal pulses and cannot feel one of the pulses. The feet are equally warm. You find that both great toes are pink, with a capillary refill within 2 seconds. Which of the following statements is correct?
Selected Answer: c.
Pedal pulses are not always palpable.
• Question 8
2.5 out of 2.5 points
Which of the following are risk factors for varicose veins? (Select all that apply.)
Selected Answers: a.
Increased body mass
Lower extremity trauma
• Question 9
2.5 out of 2.5 points
You are assessing Mr. Z’s fluid volume status as a result of heart failure. If your finger depresses a patient’s edematous ankle to a depth of 6 mm, you should record this pitting as:
Selected Answer: b.