Multiple Choice And Open Questions Assignment Paper

Posted: November 6th, 2022

Choose the patient’s demographic information from the list below. (Select All That Apply)
Male
Hispanic
Caucasian
Iodine Allergy
Single
Married
Widowed
Long-distance truck driver

Select the following components that are true to the patient’s History of Present Illness. (Select All That Apply)

History of hypertension
Wound culture positive – MRSA
Confusion
Shortness of breath
Leg pain
Vision changes
Recent cat bite
Muscle weakness
Smoking history

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Essay Directions: It is important for the nurse to understand the pathology process occurring in the patient to provide proper assessments and treatment during care. Part 1 – Describe in your own words, the step-by-step pathology process of Peripheral Artery (Occlusive) Disease. Limit this section to 8 sentences. Part 2 – Describe in your own words how Peripheral Artery (Occlusive) Disease contributed to the development of cellulitis. Limit this section to 4 sentences.

Part 1

Peripheral artery disease develops when the cells lining the arterial walls are damaged or destroyed. Inflamed cells are unable to produce the typical numbers of cytokines that are needed for vasodilation and antithrombosis, as a result of the inflammation. Microphages are drawn to the endothelium cells by adhesion molecules that they produce. The macrophages subsequently cause harm to the cell by releasing a multitude of pro-inflammatory cytokines. Free radicals accumulate, producing oxidation of LDL cholesterol. This in turn promotes the production of adhesion molecules even more. Once they have amassed in large quantities, they are referred to as fatty streaks. These fatty streaks release more harmful free radicals, which causes autoimmunity, as well as more inflammatory mediators, which further damages the vessel wall. Smooth muscle cells secrete collagen across the fatty streak, resulting in the formation of a fibrous plaque. This plaque may coagulate and intrude into the artery lumen, blocking blood flow and leading to insufficient tissue perfusion. (Huether & McCance, 2017) Multiple Choice And Open Questions Assignment Paper

Reference

Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology, sixth edition. St Louis: Elsevier

Part 2

The narrowing or blocking of arteries in PAD may cause blood flow to the extremities to be reduced, which can result in the breakdown of the skin. Because of this breakdown, bacteria may be able to penetrate and create an infection. Due to the fact that PAD may induce changes in the skin, cellulitis is more likely to develop in those who have the disease. As a result, the skin becomes more prone to infection, which manifests itself as dryness, cracking, and ulceration. (Brown & Watson, 2021)

Reference

Brown, B. D., & Watson, K. L. H. (2021). Cellulitis. In StatPearls [Internet]. StatPearls Publishing.

Select the patient’s risk factor that contributes to the pathology process of Peripheral Artery (Occlusive) Disease: uncontrolled hypertension or history of cat bite

In a few words, in the blank provided, explain how the risk factor chosen contributes to the disease pathology process: _ Uncontrolled high blood pressure causes plaque formation, which results in narrowing and inhibition of flow of blood, ultimately leading to Peripheral Artery (Occlusive) Disease_______________________________________________

Select the patient’s risk factor that contributes to the pathology process of Peripheral Artery (Occlusive) Disease: Age of 25-45 years old or Age of 45 years & older

In a few words, in the blank provided, explain how the risk factor chosen contributes to the disease pathology process:

___Oder age is risk factor for Peripheral Artery (Occlusive) Disease because increasing age is associated with an increase in the prevalence of the disease. Peripheral Artery (Occlusive) is associated with considerable risks of discomfort, poor mobility, and unfavorable vascular events such as stroke and myocardial infarction._____

Select the patient’s risk factor that contributes to the pathology process of Peripheral Artery (Occlusive) Disease: smoking history or long-distance truck driver

In a few words, in the blank provided, explain how the risk factor chosen contributes to the disease pathology process: _Smoking promotes swelling and inflammation, which ultimately results in the formation of plaque. When there is an excessive buildup of plaque, the arteries might become restricted, resulting in reduced blood flow. _____________________________________

Select the patient’s risk factors that contribute to developmentof nephrotoxicity. (Select All that Apply) Multiple Choice And Open Questions Assignment Paper

History of hypertension
Obesity
IV Vancomycin
Use of narcotic analgesic
Use of OTC NSAIDs
Pain

Select the appropriate medical diagnosis, Peripheral Artery (Occlusive) Disease or Acute MRSA Cellulitisfor the signs/symptoms listed.

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If the s/s is presented by both Peripheral Artery (Occlusive) DiseaseAND Acute MRSA Cellulitis, mark < BOTH > for your answer choice.

1	Pain with ambulation	Peripheral Artery (Occlusive) Disease		Acute MRSA Cellulitis
2	Fever and chills	Peripheral Artery (Occlusive) Disease	< BOTH >	Acute MRSA Cellulitis
3	Affected extremity edema	Peripheral Artery (Occlusive) Disease	< BOTH >	Acute MRSA Cellulitis
4	Increased HR	Peripheral Artery (Occlusive) Disease		Acute MRSA Cellulitis
5	Pallor of affected extremity with elevation	Peripheral Artery (Occlusive) Disease	< BOTH >	Acute MRSA Cellulitis
6	Absent pedal pulses	Peripheral Artery (Occlusive) Disease	< BOTH >	Acute MRSA Cellulitis
7	Erythema of affected extremity in dependent position	Peripheral Artery (Occlusive) Disease		Acute MRSA Cellulitis
8	Presence of visible wound	Peripheral Artery (Occlusive) Disease		Acute MRSA Cellulitis
9	Decreased alertness/ confusion	Peripheral Artery (Occlusive) Disease	< BOTH >	Acute MRSA Cellulitis
10	Absence of affected extremity hair	Peripheral Artery (Occlusive) Disease	< BOTH >	Acute MRSA Cellulitis

Choose the non-pharmacological medical order written for Mr. Hadley with the correct nursing assessment for this specific order.
Assess pain, vital signs, and SpO₂ every 2 hours/RN evaluates pain every 4 hours
Assess pain, vital signs, and SpO₂ every 2 hours/RN continuously monitors vital signs
Oxygen as needed to keep SpO₂greater than 92%/RN evaluates oxygen saturation, greater than 92%
Oxygen as needed to keep SpO₂greater than 92%/RN evaluates respiratory rate, rhythm and depth
Choose the non-pharmacological medical order written for Mr. Hadleywith the correct nursing assessment for this specific order.(Select All that Apply) Multiple Choice And Open Questions Assignment Paper

Cardiac Diet/ RN ensures patient understanding of Na⁺ counting
Cardiac Diet/ RN ensures patient understanding of carbohydrate counting
Protein-Restricted Diet/ RN ensures patient understanding of cholesterol counting
Protein-Restricted Diet/ RN ensures patient understanding of protein counting
Protein-Restricted Diet/ RN ensures patient understanding of fat counting

Each non-pharmacological medical order informs a subsequent nursing assessment. Which of the following choices best describes the nursing assessment paired with the non-pharmacological medical order? (Select All that Apply)

Bedrest/ RN ensures the assistive device is within reach
Bedrest/ RN ensures that the bedside commode is next to the bed
Bathroom Privileges/ RN ensures the room is free of obstructions to movement
Bathroom Privileges/ RN ensures that patient can reach assistive device, if ordered
Bathroom Privileges/ RN ensures that the call bell is within reach

Review the medical orders. Based on the medical orders in the patient’s chart, which nursing intervention and paired rationale best describe the nurse’s action? (Select One Correct Response for Each Pair)

Pair 1: Provide supplemental oxygen PRN.

Rationale: Supplemental oxygen may help compensate for the increased oxygen demands needed for wound healing.

Pair 1: Provide supplemental oxygen PRN.

Rationale: Supplemental oxygen aids in nerve regeneration.

Pair 2: Assess wound.

Rationale: Frequent wound assessment will provide evidence of bacterial resistance to antibiotics.

Pair 2: Assess wound.

Rationale: Frequent wound assessment allows for rapid detection of deterioration or improvement.

Pair 3: Call for Temp greater than 102^ₒ

Rationale: Notifying provider of fever will allow for rapid treatment and detection of sepsis.

Pair 3: Call for Temp greater than 102^ₒ

Rationale: Notifying provider of fever will provide data about patient’s level of comfort.

Pair 4: Call for HR greater than 90beats/min

Rationale: In patients with infection, heart rate greater than 90 beats/min is a SIRS criterion.

Pair 4: Call for HR greater than 90 beats/min

Rationale: In patients with infection, heart rate may be elevated due to pain.

Place your pin on the statement in the reference below that best indicates the rationale for Hadley’s recent Bilateral LE Duplex ultrasound.

(Hot Spot: To earn credit for this question, the point of your pin must be placed directly on the words of the statement that answers the question prompt.)

Place your pin on the statement in the reference below that best indicates the rationale for Hadley’smost recent Vancomycin level.

(Hot Spot: To earn credit for this question, the point of your pin must be placed directly on the words of the statement that answers the question prompt.) Multiple Choice And Open Questions Assignment Paper

Place your pin on the statement in the reference below that best indicates the rationale for Hadley’sCBC with Differential:

(Hot Spot: To earn credit for this question, the point of your pin must be placed directly on the words of the statement that answers the question prompt.)

Place your pin on the statement in the reference below that best indicates Hadley’s stage of chronic kidney disease, based on the most recent Creatinine Clearance(CrCl = GFR) level.

(Hot Spot: To earn credit for this question, the point of your pin must be placed directly on the words of the statement that answers the question prompt.)

Place your pin on the word or statement in the reference below that best explains the patient’s indication for taking this medication, enalapril. The indications are bulleted and in bold font in this drug guide.

(Hot Spot: To earn credit for this question, the point of your pin must be placed directly on the word or statement that answers the question prompt.) Multiple Choice And Open Questions Assignment Paper

You will use the medication enalapril to answer questions 17-22.

Choose enalapril’s mechanism of action:

Blocks angiotensin II receptorsor

Blocks the conversion of angiotensin I to angiotensin II

The rationale for treating the pathology changes in this patient:

This action increases peripheral arterial resistance, resulting in reduction of BPor

This action prevents the vasoconstrictive action of angiotensin II, resulting in reduction of BP

Choose your action when the next enalapril dose is due for Mr. Hadley:

Note: If the nurse does not have any contraindications, you would select no concerns. If the nurse has reason to believe there have been influential lab or vital sign changes, you would select the appropriate reason for why the medication was held or administered.

Administer the medicationor

Hold the medication

Choose the option that reflects the reason for your action:

Lab value changesor

No concerns with this medicationor

Vital sign changes

The nurse must assess the patient for several signs/symptoms/lab values when determining whether to administer or hold medications. Thinking about enalapril, what assessments would be appropriate for patients (*in general), when determining whether to administer or hold the prescribed dose.

Choose the nursing action paired with the appropriate assessment required to administer or hold enalapril safely. (Select All That Apply)

*In general = not specific to this patient, this means when giving the medication “in general” Multiple Choice And Open Questions Assignment Paper

give medication for blood pressure of 156/92 mmHg
give medication to patient with pedal edema
hold medication due to missing breakfast
hold medication if patient complains of changes in hearing
hold medication for serum K+ greater than 5.5 mEq/L

The nurse decides what interventions are appropriate when administering or holding medications. Thinking about enalapril, what nursing interventions would be appropriate for patients (*in general), after the nurse has decided to administer or hold a patient’s dose of medication.

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Choose the nursing interventions required when deciding to administer or hold enalapril safely. (Select All That Apply)

*In general = not specific to this patient, this means when giving the medication “in general”

notify the prescriber if the medication is held
if the provider is notified about holding the dose, you do not need to document that in the MAR
when administering enalapril IV, administer slowly, over 5 minutes
nurse will assess for hypotension after first dose
nurse will assess for pregnancy, prior to administering drug

Choose the outcome the nurse will assess to determine effectiveness of the enalapril.

signs of fluid volume excess are minimal
the patient feels dizzy when standing
blood pressure is within normal limits
pupils are round and reactive to light

Place your pin on the word or statement in the reference below that best explains the patient’s indication for taking this medication, The indications are bulleted and in bold font in this drug guide.

(Hot Spot: To earn credit for this question, the point of your pin must be placed directly on the word or statement that answers the question prompt.)

You will use the medication ibuprofen to answer questions 23-28.

Choose ibuprofen’s mechanism of action:

decreases awareness of pain by binding with opioid receptors in CNSor

reduces the production of prostaglandins at site of inflammation

The rationale for treating the pathology changes in this patient:

Reduces painor

Enhances pain

Choose your action when Mr. Hadley requests ibuprofen for pain:

Administer the medicationor

Do not administer the medication

Choose the option that reflects the reason for your action:

Lab or vital sign changesor

No concerns with this medicationor

No order available

The nurse must assess the patient for several signs/symptoms/lab values when determining whether to administer or hold medications. Thinking about ibuprofen, what assessments would be appropriate for patients (*in general), when determining whether to administer or hold the prescribed dose.

Choose the nursing action paired with the appropriate assessment required to administer or hold ibuprofen safely. (Select All That Apply)

*In general = not specific to this patient, this means when giving the medication “in general”

hold the medication if the patient has a history of gastritis
hold the medication if patients is currently experiencing bleeding
give the medication if patient has history of heart attack or stroke
give the medication if the patient is vomiting
give the medication for mild to moderate pain

The nurse decides what interventions are appropriate when administering or holding medications. Thinking about ibuprofen, what nursing interventions would be appropriate for patients (*in general), after the nurse has decided to administer or hold a patient’s dose of medication. Multiple Choice And Open Questions Assignment Paper

Choose the nursing interventions required when deciding to administer or hold ibuprofen safely. (Select All That Apply)

*In general = not specific to this patient, this means when giving the medication “in general”

assess for drug-drug interactions
give the medication with milk or meal
check blood pressure after administration
evaluate pain level before administration
evaluate renal function during administration
monitor for GI bleed during administration
Choose the outcome the nurse will assess to determine effectiveness of ibuprofen.

the patient has reduced pedal edema
the patient is eating more vegetables
the patient has reduced pain
the blood pressure remains within normal limits

Place your pin on the word or statement in the reference below that best explains the patient’s indication for taking this medication, Vancomycin. The indications are in bold font in this drug guide.

(Hot Spot: To earn credit for this question, the point of your pin must be placed directly on the word or statement that answers the question prompt.)

You will use the medication Vancomycin to answer questions 29-34.

Choose Vancomycin’s mechanism of action:

Interferes with bacterial DNA synthesisor

Weakens bacterial cell wall

The rationale for treating the pathology changes in this patient:

Treat infection caused by sensitive, gram-positive organismor

Treat infection caused by sensitive, gram-negative organism

Choose your action when the next Vancomycin dose is due for Mr. Hadley:

Administer the medicationor

Hold the medication

Choose the option that reflects the reason for your action:

Lab changesor

No concerns with this medicationor

Vital sign changes

The nurse must assess the patient for several signs/symptoms/lab values when determining whether to administer or hold medications. Thinking about Vancomycin, what assessments would be appropriate for patients (*in general), when determining whether to administer or hold the prescribed dose.

Choose the nursing action paired with the appropriate assessment required to administer or hold Vancomycin safely. (Select All That Apply)

*In general = not specific to this patient, this means when giving the medication “in general”

administer medication after collecting culture specimens
administer medication if CrCl is within normal limits
hold the medication for one incident of mild diarrhea
hold medication for fever greater than 102 F
hold the medication if patient complains of new-onset tinnitus

The nurse decides what interventions are appropriate when administering or holding medications. Thinking about Vancomycin, what nursing interventions would be appropriate for patients (*in general), after the nurse has decided to administer or hold a patient’s dose of medication.

Choose the nursing interventions paired with the appropriate rationales required when deciding to administer or hold Vancomycin safely. (Select All That Apply)

*In general = not specific to this patient, this means when giving the medication “in general”

administer medication after evaluating patent IV access
after administration, assess IV site for swelling and erythema
it is appropriate to hold the Vancomycin if patient reports no fever
after administration monitor the patient for onset of nausea, abdominal pain or diarrhea
teach patient to monitor heart rate

Choose the outcome the nurse will assess to determine effectiveness of the Vancomycin.

fever resolves
infection is eliminated
absence of pitting edema and improved exercise tolerance
no nausea is reported

Place your pin on the word or statement in the reference below that best explains the patient’s indication for taking this medication, acetaminophen. The indications are bulleted and in bold font in this drug guide.

(Hot Spot: To earn credit for this question, the point of your pin must be placed directly on the word or statement that answers the question prompt.)

You will use the medication acetaminophen to answer questions 35-40.

Choose acetaminophen’s mechanism of action:

Reduces production of prostaglandins local site of inflammationor

Reduces production of prostaglandins in CNS

The rationale for treating the pathology changes in this patient:

Relief of pain and reduction of feveror

Relief of swelling and warmth at site of inflammation

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Choose your action when Mr. Hadley asks for acetaminophen for pain, at noon:

Administer the medicationor

Hold the medication

Choose the option that reflects the reason for your action:

Too soon to administeror

No concerns with this medicationor

Vital sign changes

The nurse must assess the patient for several signs/symptoms/lab values when determining whether to administer or hold medications. Thinking about acetaminophen, what assessments would be appropriate for patients (*in general), when determining whether to administer or hold the prescribed dose.Multiple Choice And Open Questions Assignment Paper

Choose the nursing action paired with the appropriate assessment required to administer or hold acetaminophen safely. (Select All That Apply)

*In general = not specific to this patient, this means when giving the medication “in general”

give medication if mild to moderate pain is reported
give medication if patient reports allergy to Tylenol™
hold medication if excessive
give medication if fever greater than 101 F
hold medication if there is new onset of skin rash

The nurse decides what interventions are appropriate when administering or holding medications. Thinking about acetaminophen, what nursing interventions would be appropriate for patients (*in general), after the nurse has decided to administer or hold a patient’s dose of medication.

Choose the nursing interventions paired with the appropriate rationales required when deciding to administer or hold acetaminophen safely. (Select All That Apply)

*In general = not specific to this patient, this means when giving the medication “in general”

administermedication with food to prevent gastritis
administer IV diluted, as required per drug reference
nurse will calculate maximum daily dose, including all routes and forms of drug
after IV administration, assess pain in 1 hour, at time of peak action
if patient is nauseated, request rectal route
Choose the outcome the nurse will assess to determine effectiveness of the acetaminophen.
there is less extremity edema
the patient is sedated
the patient reports reduced pain
the wound is less erythematous

@Hice, Karmen for this question, would you like to keep long-term alcohol use? I think maybe a different word choice like “chronic binge drinking” or “excessive alcohol use” may better reflect that we want to hold Tylenol if there is a history of liver damage, hepatic impairment, or cirrhosis no matter what the cause. [WK1]

I just don’t want to confuse their thinking because book says “patients who consume large quantities of alcohol, smoke, and take antiseizure medications are at high risk for hepatotoxicity with usual therapeutic doses.” However, other scholarly sources like lexicomp state say “Chronic alcoholics who take therapeutic doses of acetaminophen are NOT at an increased risk of hepatotoxicity. In contrast, chronic alcoholics who ingest repeated supratherapeutic doses of acetaminophen are at an increased risk for hepatotoxicity.”

Change it! I’m totally fine with that! If you see somewhere that the wording could be tweaked… for better understanding, please feel free to do so! [HK2] Multiple Choice And Open Questions Assignment Paper

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