Nursing

Journal: Community Health Promotion Methods
Journal: Community Health Promotion Methods
Permalink:
Week Five Journal – Competencies
Each week of this course, you will be reviewing and reflecting upon the national competencies for health education specialists. There are seven areas of responsibility that you will review in depth each week through your reflective journal entry.
Visit the (NCHEC) website and download a copy of the . This document is considered “The Bible” for health educators as it shows the competencies that are firmly established as the national standards for the field. All total, there are 258 sub-competencies organized into 36 competencies within seven major areas of responsibility.
For Week Four, you will focus on Area 7: Communicate, Promote, and Advocate for Health, Health Education/Promotion, and the Profession. Area 7 contains four competencies and many sub-competencies, which are listed in the PDF document (from 7.1 to 7.4.11). In your journal this week, review this area in its entirety, and address the following:
Imagine that you are the Senior Health Education Specialist for your community. Describe a pressing health issue in your community (e.g., high smoking rates, high substance abuse, low compliance with the seatbelt laws, significant adult onset diabetes, etc.).
Using your skills (as listed in this competency area), how would you tackle this health issue? In your response, you must apply at least three of the competencies/sub-competencies noted in Area 7 and be specific in how you plan to apply those competencies. Please note that simply stating you would “use No. 7.2.9” is not enough. Explain how and why you would use that sub-competency.
Your journal entry may be a PowerPoint presentation, video, screencast, or a typed document. You will submit your work through Waypoint. No APA formatting is necessary. All presentations must be at least 5 minutes in length. If you use a video or screencast, please make sure you copy the link onto a Word document and then upload the document. This is reflection work and the goal is to critically look at the competencies as well as your insights and beliefs into how they fit into the health educator’s daily routine. There are no right or wrong answers; this is pure personal reflection.

Assignment: Factors Leading to Polypharmacy
Assignment: Factors Leading to Polypharmacy
Week 2 discussion
DQ1 Polypharmacy Discussion
Students will not receive credit for any discussions posted after Sunday 11:59pm MT.
Polypharmacy is a common concern, especially in the elderly.
List the definitions of polypharmacy you encounter in your readings. There is more than one.
Discuss three risk factors that can lead to polypharmacy. Explain the rationale for why each listed item is a risk factor. This is different than adverse drug reactions. ADRs can be a result of polypharmacy, and is important, but ADRs are not a risk factor.
Discuss three action steps that a provider can take to prevent polypharmacy.
Provide an example of how your clinical preceptors have addressed polypharmacy.
DQ2 ACC/AHA Guidelines Discussion
Chief complaint: medication refill “ran out of medicine”
HPI: BJ, a 68-year-old AA female presents to the clinic for prescription refills. The patient also indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with activity, especially when she is playing with her grandchildren but it goes away once she sits down to rest. She reports that she is also bothered by shortness of breath that wakes her up at night, but it resolves after sitting upright on 3 pillows. She also has lower leg edema which started 1 week ago. She also indicates that she often feels light headed and faint while going up the stairs, but it subsides after sitting down to rest. She has not tried any OTC medications at home. She never filled her prescriptions, which she received at her checkup 6 months ago, she did not think it was important.
PMH:
Hypertension
Previous history of MI in 2010
Surgeries:
2010-Left Anterior Descending (LAD) cardiac stent placement
Allergies: Amoxicillin
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Has never had a Pneumovax
Has not had a Td in over 20 years
Has not had the herpes zoster vaccine
Social history:
High school graduate, a widow with one son who loves out of state. She drinks one 4-ounce glass of red wine daily. She is a former smoker that stopped 20 years ago.
Family history:
Both parents are deceased. Father died of a heart attack; mother died of natural causes. She had one brother who died of a heart attack 20 years ago at the age of 52.
ROS:
Constitutional: Lightheaded and faint with exertion.
Respiratory: Shortness of breath with exertion (playing with grandchildren and stairs). + Orthopnea
Cardiovascular: + leg and ankle swelling x 1 week
Psychiatric: Not taking medications for 6 months – “ran out”
Physical examination:
Vital Signs
Height: 5 feet 2 inches Weight: 163 pounds BMI: 29.8 BP 150/86 T 98.0 oral P 100 R 22, non-labored;
HEENT: normocephalic, symmetric. Bilateral cataracts; PERRLA, EOMI; Upper and lower dentures in place a fitting well. No tinnitus
NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. Thyroid non-palpable
LUNGS: inspiratory crackles
HEART: Normal S1 with S2 split during expiration. An S4 is noted at the apex; systolic murmur noted at the right upper sternal border without radiation to the carotids.
ABDOMEN: Normal contour; active bowel sounds all four quadrants; no palpable masses.
PV: Pulses are 2+ in upper extremities and 1+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally
GENITOURINARY: no CVA tenderness; not examined
MUSCULOSKELETAL: Heberden’s nodes at the DIP joints of all fingers and crepitus of the bilateral knees on flexion and extension with tenderness to palpation medially at both knees. Kyphosis and gait slow, but steady.
PSYCH: normal affect; her Mini-Cog Score is 3. Her PHQ-9 score is 22.
SKIN: Sparse hair noted on lower legs and feet bilaterally with dry skin on her ankles and feet.
Labs:: Hgb 12.2, Hct 37%, K+ 4.2, Na+140, Cholesterol 230, Triglycerides 188, HDL 37, LDL 190, TSH 3.7, glucose 98 BUN 12 Cr 0.8
A:
Primary Diagnosis:
Congestive Heart Failure (CHF) (150.9)
Secondary Diagnoses:
Primary Hypertension (I10)
Depression F32.3:
Obesity (E66):
Osteoarthritis (OA) (715.90)
Differential Diagnosis:
Peripheral Vascular Disease (PVD) (173.9)
P:
Medications:
Sertraline 25 mg. Take 1 tab PO QD disp#30, 1 refill
Tylenol 650 mg PO Q4 hours as needed for arthritis pain
Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH.
12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index
Education:
Congestive heart failure is caused by the inability of your heart to pump blood effectively enough to meet the demands of your body. If you think of your body as any other pump, if fluid does not move well through the system, then it will back up into other spaces. When blood backs up it puts a lot of pressure on the blood vessels, which forces fluid to leak out into the nearby tissue. With CHF, this fluid usually moves into your lungs, legs, or abdomen.
The signs of worsening CHF include decreased energy level, shortness of breath during your normal routine, increased swelling to your legs and feet, your clothes feel tight, or a wet sounding cough. Call the office if these symptoms occur.
Weigh yourself every morning at the same time. If you have a 3 pound weight gain in 24 hours, or a 5 pound weight gain over a week, you should call the office.
Exercise and maintaining a normal weight is very important. You should try to exercise at least 20-30 minutes a day, more if possible. Start slow with walking.
Decrease your salt intake. Do not add any extra salt to foods. Salt makes you retain fluid, and it makes you want to drink more fluid. Avoid fast food and prepared food as they are usually very high in sodium.
If you notice your legs swelling, elevate them up and rest. Do not drink alcohol and continue to avoid smoking or second hand smoke.
Take your medications as directed, with water. Do not stop them abruptly or skip doses.
I have started you on a medication for depression. It can take 2 weeks to start to feel it working and up to a month until you can fell the real benefits.
If you start to feel more depressed, like you want to harm yourself or others, please contact me right away or got to the ER.
Referrals: may refer based on lab results
Follow up: return to office in 2 weeks
Additional lab results:
Echo results: LVEF 39%
BNP – 682 pg/ml
Questions: You determine the medications for CHF/ASCVD
According to the ACC/AHA Guidelines, what is BJ’s heart failure stage?
According to the ACC/AHA Guidelines, what medications should BJ be prescribed?
Does she need any additional medication given her history of MI?
Write her complete prescriptions using the prescription writing format.
Assignment: Factors Leading to Polypharmacy
Assignment: Factors Leading to Polypharmacy

Assignment: Discuss Gynecologic Health
Assignment: Discuss Gynecologic Health
Select a patient that you examined as a nurse practitioner student during the last three weeks of clinical on OB/GYN Issue. With this patient in mind, address the following in a SOAP Note 1 OR 2 PAGES :
Subjective: What details did the patient provide regarding her personal and medical history?
Objective: What observations did you make during the physical assessment?
Permalink:
Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters for this patient , as well as a rationale for this treatment and management plan.
Very Important: Reflection notes: What would you do differently in a similar patient evaluation?
Reference
Gagan, M. J. (2009). The SOAP format enhances communication. Kai Tiaki Nursing New Zealand, 15(5), 15.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.
Chapter 6, “Care of the Well Woman Across the Life Span” ,“Care of the Woman Interested in Barrier Methods of Birth Control” (pp. 275–278)
Chapter 7, “Care of the Woman with Reproductive Health Problems”
“Care of the Woman with Dysmenorrhea” (pp. 366–368)
“Care of the Woman with Premenstrual Symptoms, Syndrome (PMS), or Dysphoric Disorder (PMDD)” (pp. 414–418)
Gynecologic Health
Select a patient that you examined as a nurse practitioner student during the last three weeks of clinical on OB/GYN Issue. With this patient in mind, address the following in a SOAP Note 1 OR 2 PAGES :
Subjective: What details did the patient provide regarding her personal and medical history?
Objective: What observations did you make during the physical assessment?
Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters for this patient , as well as a rationale for this treatment and management plan.
Very Important: Reflection notes: What would you do differently in a similar patient evaluation?
Reference
Gagan, M. J. (2009). The SOAP format enhances communication. Kai Tiaki Nursing New Zealand, 15(5), 15.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.
Chapter 6, “Care of the Well Woman Across the Life Span” ,“Care of the Woman Interested in Barrier Methods of Birth Control” (pp. 275–278)
Chapter 7, “Care of the Woman with Reproductive Health Problems”
“Care of the Woman with Dysmenorrhea” (pp. 366–368)
“Care of the Woman with Premenstrual Symptoms, Syndrome (PMS), or Dysphoric Disorder (PMDD)” (pp. 414–418)

Discuss Two Implications For Nursing.
Discuss Two Implications For Nursing.
During your practicum, determine what clinical problem or issue the organization is facing. Discuss two implications for nursing.
Permalink:
Discuss Two Implications For Nursing.
Discuss Two Implications For Nursing.
Discuss Two Implications For Nursing.
Discuss Two Implications For Nursing.
Discuss Two Implications For Nursing.
Assignment: Health Information Patient Handout
One of the pivotal goals of consumer health literacy efforts is to design educational materials that attract as well as educate users. In this Assignment, you design a health information document on a topic that is of interest to you.
To prepare:
Select a health issue of interest to you.
Identify the audience or population that you seek to educate about this issue.
Search the Internet to find credible sites containing information about your selected topic.
Review the two health literacy websites listed in this week’s Learning Resources. Focus on strategies for presenting information.
To complete:
Design an educational handout on the health issue you selected.
Include a cover page.
Include an introduction that provides:
An explanation of your issue and why you selected it
A description of the audience you are addressing
In the handout itself:
Develop your handout in such a way that it attracts the attention of the intended audience.
Include a description of the health issue and additional content that will enhance your message (i.e., key terms and definitions, graphics, illustrations, etc.).
Recommend four or five sites that provide clear, valuable, and reliable information on the topic.
Note: Remember to keep the information in your health handout and its design at the appropriate level for the audience you are seeking to inform. Submit your Assignment as a Word document.
This week we will discuss the security of health care records and the protection of patient privacy. You will analyze the nurse’s responsibility to protect patient information and the extent that Health IT has made it easier or more difficult to protect patient privacy. You will comment on any security or ethical issues related to the use of portable devices to store information. You will also assess the strategies your organization uses to safeguard patient information and how these promote a culture of safety. You will describe an area where improvement is needed and one strategy that could address the situation.
NURS 5051/6051: Week 11, Application Assignment Rubric
REQUIRED CONTENT EVALUATION
EXCELLENT
EVALUATION
GOOD
EVALUATION
FAIR
EVALUATION
POOR
SCORE
Includes a cover page and introduction forthe flyer with an explanation of the issue selected, a description of the audience, and the search terms used to identify resources.
(10 possible points)
This section demonstrates excellence. To achieve a rating of “excellent” the student must discuss all of the concepts and key points presented in the text/s and Learning Resources. Paper provides significant detail including multiple relevant examples, evidence from the readings and other peer reviewed sources published within the past 5 years, and discerning ideas.
(9–10 points)
This section demonstrates a good understanding of the content. To achieve a rating of “good” the student must discuss most of the concepts and key points presented in the text/s and Learning Resources. Paper includes moderate detail, evidence from the readings, and discerning ideas.
(8 points)
This section demonstrates a fairunderstanding of the content. To achieve a rating of “fair” the student must discuss some of the concepts and key points as presented in the text/s and Learning Resources. Paper may be lacking in detail and specificity and/or may not include sufficient pertinent examples or provide sufficient evidence from the readings.
(7 points)
This section demonstrates poor understanding of the content. To achieve a rating of “poor”, the student includes few of the concepts and key points of the text/s and Learning Resources. Paper is missing detail and specificity and/or does not include any pertinent examples or provide sufficient evidence from the readings.
(0–6 points)
In the Flyer:
Defines key terms in a way that is appropriate for the target audience.
(10 possible points)
This section demonstrates excellence. To achieve a rating of “excellent” the student must discuss all of the concepts and key points presented in the text/s and Learning Resources. Paper provides significant detail including multiple relevant examples, evidence from the readings and other peer reviewed sources published within the past 5 years, and discerning ideas.
(9–10 points)
This section demonstrates a good understanding of the content. To achieve a rating of “good” the student must discuss most of the concepts and key points presented in the text/s and Learning Resources. Paper includes moderate detail, evidence from the readings, and discerning ideas.
(8 points)
This section demonstrates a fairunderstanding of the content. To achieve a rating of “fair” the student must discuss some of the concepts and key points as presented in the text/s and Learning Resources. Paper may be lacking in detail and specificity and/or may not include sufficient pertinent examples or provide sufficient evidence from the readings.
(7 points)
This section demonstrates poor understanding of the content. To achieve a rating of “poor”, the student includes few of the concepts and key points of the text/s and Learning Resources. Paper is missing detail and specificity and/or does not include any pertinent examples or provide sufficient evidence from the readings.
(0–6 points)
Describes the health issue using language appropriate for the audience.
(20 possible points)
This section demonstrates excellence. To achieve a rating of “excellent” the student must discuss all of the concepts and key points presented in the text/s and Learning Resources. The section provides significant detail including multiple relevant examples, evidence from the readings and other peer reviewed sources published within the past 5 years, and discerning ideas.
(19–20 points)
This section demonstrates a good understanding of the content. To achieve a rating of “good” the student must discuss most of the concepts and key points presented in the text/s and Learning Resources. The section includes moderate detail, evidence from the readings, and discerning ideas.
(17–18 points)
This section demonstrates a fairunderstanding of the content. To achieve a rating of “fair” the student must discuss some of the concepts and key points as presented in the text/s and Learning Resources. The section may be lacking in detail and specificity and/or may not include sufficient pertinent examples or provide sufficient evidence from the readings.
(15–16 points)
This section demonstrates poor understanding of the content. To achieve a rating of “poor”, the student includes few of the concepts and key points of the text/s and Learning Resources. The section is missing detail and specificity and/or does not include any pertinent examples or provide sufficient evidence from the readings.
(0–14 points)
Provides guidance on how to identify websites and resources with credible information on the issue.
(20 possible points)
This section demonstrates excellence. To achieve a rating of “excellent” the student must discuss all of the concepts and key points presented in the text/s and Learning Resources. The section provides significant detail including multiple relevant examples, evidence from the readings and other peer reviewed sources published within the past 5 years, and discerning ideas.
(19–20 points)
This section demonstrates a good understanding of the content. To achieve a rating of “good” the student must discuss most of the concepts and key points presented in the text/s and Learning Resources. The section includes moderate detail, evidence from the readings, and discerning ideas.
(17–18 points)
This section demonstrates a fairunderstanding of the content. To achieve a rating of “fair” the student must discuss some of the concepts and key points as presented in the text/s and Learning Resources. The section may be lacking in detail and specificity and/or may not include sufficient pertinent examples or provide sufficient evidence from the readings.
(15–16 points)
This section demonstrates poor understanding of the content. To achieve a rating of “poor”, the student includes few of the concepts and key points of the text/s and Learning Resources. The section is missing detail and specificity and/or does not include any pertinent examples or provide sufficient evidence from the readings.
(0–14 points)
Recommends 4-5 websites with clear, valuable, and reliable information on the issue.
(10 possible points)
This section demonstrates excellence. To achieve a rating of “excellent” the student must discuss all of the concepts and key points presented in the text/s and Learning Resources. The section provides significant detail including multiple relevant examples, evidence from the readings and other peer reviewed sources published within the past 5 years, and discerning ideas.
(9–10 points)
This section demonstrates a good understanding of the content. To achieve a rating of “good” the student must discuss most of the concepts and key points presented in the text/s and Learning Resources. The section includes moderate detail, evidence from the readings, and discerning ideas.
(8 points)
This section demonstrates a fairunderstanding of the content. To achieve a rating of “fair” the student must discuss some of the concepts and key points as presented in the text/s and Learning Resources. The section may be lacking in detail and specificity and/or may not include sufficient pertinent examples or provide sufficient evidence from the readings.
(7 points)
This section demonstrates poor understanding of the content. To achieve a rating of “poor”, the student includes few of the concepts and key points of the text/s and Learning Resources. The section is missing detail and specificity and/or does not include any pertinent examples or provide sufficient evidence from the readings.
(0–6 points)
Writing used in Introduction
(10 possible points)
Paper is well organized, uses scholarly tone, follows APA style, uses original writing and proper paraphrasing, contains very few or no writing and/or spelling errors, and is fully consistent with graduate level writing style. Introduction contains multiple, appropriate and exemplary peer reviewed sources (published within the past 5 years) expected/required for the assignment.
(9–10 points)
Paper is mostly consistent with graduate level writing style. Paper may have some small or infrequent organization, scholarly tone, or APA style issues, and/or may contain a few writing and spelling errors, and/or somewhat less than the expected number of or type of sources.
(8 points)
Paper is somewhat below graduate level writing style, with multiple smaller or a few major problems. Paper may be lacking in organization, scholarly tone, APA style, and/or contain many writing and/or spelling errors, or shows moderate reliance on quoting vs. original writing and paraphrasing. Paper may contain inferior resources (number or quality).
(7 points)
Paper is well below graduate level writing style expectations for organization, scholarly tone, APA style, and writing, or relies excessively on quoting. Paper may contain few or no quality resources.
(0–6 points)
Writing used in Flyer
(20 possible points)
Flyer is well organized, uses a tone appropriate for the audience, uses original writing and proper paraphrasing, contains very few or no writing and/or spelling errors, and is fully consistent with a health flyer writing style.
(18–20 points)
Flyer mostly uses a tone appropriate for the intended audience. Flyer may have some small or infrequent organization, tone issues, and/or may contain a few writing and spelling errors.
(16–17 points)
Flyer is written in a tone that is somewhat above or below the intended audience, with multiple smaller or a few major problems. Flyer may be lacking in organization, appropriate tone, and/or contain many writing and/or spelling errors, or shows moderate reliance on quoting vs. original writing and paraphrasing.
(14–15 points)
Flyer is well below graduate level work, expectations for organization, appropriate tone, and writing.
(0–13 points)
Instructor comments:
Up to 20 points may be deducted for lateness.
Total Score (100 possible points):
points
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 17, “Supporting Consumer Information and Education Needs”This chapter explores health literacy and e-health. The chapter examines a multitude of technology-based approaches to consumer health education.
Chapter 18, “Using Informatics to Promote Community/Population Health”In this chapter, the authors supply an overview of community and population health informatics. The authors explore a variety of informatics tools used to promote community and population health.
Chapter 16, “Informatics Tools to Promote Patient Safety and Clinical Outcomes”The authors of this chapter present strategies for developing a culture of safety using informatics tools. In addition, the chapter analyzes how human factors contribute to errors.
Health literacy: How do your patients rate? (2011). Urology Times, 39(9), 32.
Retrieved from the Walden Library databases.
The authors of this article define health literacy and emphasize its poor rates in the United States. Additionally, the authors recommend numerous websites that offer patient education materials.
Huff, C. (2011). Does your patient really understand? H&HN, 85(10), 34.
Retrieved from the Walden Library databases.
This article defines hospital literacy and highlights the barriers that prevent it from increasing. It also emphasizes the difficulties created by language and financial costs.
The Harvard School of Public Health. (2010). Health literacy studies. Retrieved from http://www.hsph.harvard.edu/healthliteracy
This website provides information and resources related to health literacy. The site details the field of health literacy and also includes research findings, policy reports and initiatives, and practice strategies and tools.
Office of Disease Prevention and Health Promotion (n.d.). Health literacy online. Retrieved June 19, 2012, from http://www.health.gov/healthliteracyonline/
This webpage supplies a guide to writing and designing health websites aimed at increasing health literacy. The guide presents six strategies that should be used when developing health websites.
U.S. Department of Health and Human Services. (n.d.a). Quick guide to health literacy. Retrieved June 19, 2012, from http://www.health.gov/communication/literacy/quickguide/Quickguide.pdf
This article contains an overview of key health literacy concepts and techniques for improving health literacy. The article also includes examples of health literacy best practices and suggestions for improving health literacy.
Required Media
Agency for Healthcare Research and Quality (Executive Producer). (2012a). Interview with Rachelle Toman, M.D. Ph.D. Rockville, MD: Author. Retrieved from http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/videos/clinician06/index.html
In this interview, Dr. Toman discusses the importance of asking patients questions to ensure they have been able to sufficiently communicate their concerns.
APA FORMAT

Peptic Ulcer With Ranitidine (Zantac)
Peptic Ulcer With Ranitidine (Zantac)
Question 1 A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is
A) headache
B) irritability
C) dry mouth
D) heart palpitations
Question 2 A patient on 5-FU calls the clinic and reports that he has between five and seven loose bowel movements daily. The nurse will instruct the patient to
Permalink:
A) treat the diarrhea with OTC medications
B) avoid protein-rich foods
C) avoid grapefruit and grapefruit juice
D) notify the clinic if the stools are black or if there is evidence of blood
Question 3 A patient has been prescribed a histamine-2 (H2) receptor antagonist for the treatment of GERD. Why are H2RAs more effective than H1 receptor antagonists in the treatment of diseases of the upper GI tract?
A) H2RAs have a longer duration of action and fewer adverse effects than H1RAs
B) The parietal cells of the stomach have H2 receptors but not H1 receptors
C) H2RAs may be administered orally and in an outpatient environment but H1RAs require intravenous administration
D) H2 receptors in the upper GI tract outnumber H1 receptors by a factor of 2:1
Question 4 To maximize the therapeutic effect of diphenoxylate HCl with atropine sulfate, the nurse will instruct the patient to take the medication
A) once a day
B) twice a day
C) every 2 hours
D) four times a day
Permalink:
Question 5 A 22-year-old male college senior has lived with a diagnosis of Crohn’s disease for several years and has undergone several courses of treatment with limited benefit. Which of the following targeted therapies has the potential to alleviate the symptoms of Crohn’s disease?
A) Tositumomab plus 131I (Bexxar)
B) Muromonab-CD3 (Orthoclone OKT3)
C) Infliximab (Remicade)
D) Eculizumab (Soliris)
Question 6 A patient has been prescribed rabeprazole (Aciphex). It will be important for the nurse to assess the patient’s drug history to determine if the patient is taking which of the following drugs?
A) Levodopa
B) Morphine
C) Digoxin
D) Dicyclomine hydrochloride
Question 7 An adult patient who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin. The nurse has conducted patient teaching about the possibility of nausea and vomiting. In order to reduce the patient’s risk of severe nausea, the nurse should
A) place the patient on a low-residue diet
B) ensure that the patient is NPO from midnight prior to receiving the drug
C) administer a combination of antiemetics prior to the administration of the drug
D) encourage the patient to request antiemetics if the nausea becomes unbearable
Question 8 It is determined that a patient, who is in a hepatic coma, needs a laxative. Lactulose is prescribed. Which of the following should the nurse monitor to assess the efficacy of the lactulose therapy?
A) Water levels in the colon
B) Oncotic pressure in the colon
C) Blood ammonia levels
D) Relief from symptoms
Question 9 A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The patient states,“I take it as soon as I feel heartburn coming on, but it doesn’t seem to help at all.” How should the nurse best respond to this patient’s statement?
A) “It could be that Prilosec isn’t the right drug for you, so it would be best to talk this over with your care provider.”
B) “Prilosec won’t really decrease the sensation of heartburn, but it is still minimizing the damage to your throat and stomach that can be caused by the problem.”
C) “Prilosec will help your heartburn but it’s not designed to provide immediate relief of specific episodes of heartburn.”
D) “A better strategy is to take a dose of Prilosec 15 to 30 minutes before meals or drinks that cause you to get heartburn.”
Question 10 A 33-year-old woman has irritable bowel syndrome (IBS). The physician has prescribed simethicone (Mylicon) for her discomfort.Which of the following will the nurse monitor most closely during the patient’s drug therapy?
A) Drug toxicity
B) Anorexia
C) Increased abdominal pain and vomiting
D) Increased urine output
Question 11 Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced occasional constipation in recent months. What remedy should be the nurse’s first suggestion?
A) Bismuth subsalicylate
B) A bulk-forming (fiber) laxative
C) A stimulant laxative
D) A hyperosmotic laxative

Assignment: Immigration US Controversial Issue
Assignment: Immigration US Controversial Issue
CHOOSE ONE of the following options, responding and providing feedback to others according to the rubrics. Original posts must be between 350 and 500 words and a minimum of 100-150 words for a response post. You must include quotes and reference citations from an assigned reading for the week in your original post.
1. Discuss the principle of utility. Is happiness a sufficient criterion for moral worth? If it isn’t, can you name a better or more appropriate criterion?
2. Immigration has been and continues to be a controversial issue in the U.S., as well as in other countries. Large numbers of refugees have fled from war, persecution, oppression, famine, and drought. Hundreds of thousands of people migrate to the U.S. and Europe to perform agricultural and low-paying jobs, often jobs that locals refuse to do. Given its history and social evolution, what should be the criteria, for the U.S., on Immigration? On what premises would you fashion U.S. policy on Immigration, which includes those who arrive or remain in country without proper documentation? What social, economic, ethical and humanitarian factors should be taken into account? And what should be done regarding the millions of undocumented immigrants currently in the U.S.? Go to for a fun cartoon.
3. Consider the charge that utilitarianism is too “backwards looking.” Another way to put this might be that it sounds too much like “the ends justify the means.” Do you find the theory susceptible to this criticism? Why or why not?
4. Using the Utilitarian approach, should the drinking age in the US be lowered to 18? Why? Why not?
5. A SCENARIO OF UTILITARIANISM: ADRIFT!
· Imagine a lifeboat adrift at sea.
· In it are
o a physician
o a police officer, accused of corruption, who’s been suspended from the police force,
o a young mother and her nursing infant
o an unemployed carpenter who volunteers twice a week at the local homeless shelter
o a teenager who performs on stage with a band
o a retired kindergarten teacher
o and you.
· Also in the boat are food and water, but not enough to last long–and the castaways do not know how long (if ever) before they’ll find land or be rescued.
· The longer they wait, the less food and water they will have left, and the weaker they become. What should they do? What would YOU do?
· This discussion is devoted to utilitarianism
–the lifeboat scenario is an example to make the ideas of the theory more real. Be sure to use utilitarian concepts in your discussion, regardless of whether you find them appealing. Be on the lookout for utilitarian ideas and principles, identify them when they pop up, and offer an assessment of how well utilitarian thinking helps you with this “lifeboat problem.”

Assignment: Biological Evolution
Assignment: Biological Evolution
Permalink:
Question 1
What is biological evolution?
the development of traits that organisms need in order to become more complex
gene changes in populations over many generations
the change that occurs in individuals as they try to survive in their environment
the steps by which the first life was created on earth from random molecules
Question 2
Which of the following BEST describes why the process of evolution is easier to study in fruit flies than in birds?
Fruit flies have a much shorter generation time than birds.
Fruit flies are smaller than birds.
Fruit flies have a simpler diet than birds.
Fruit flies do not live as long as birds.
Question 3
Which of the following groupings is the MOST appropriate according to the classification system developed by Linnaeus?
Group 1: whale, giant fruit bat, giant walking stick (an insect); Group 2: penguin, ostrich, human; Group 3: hummingbird, bee, water strider bug
Group 1: penguin, ostrich, hummingbird; Group 2: water strider bug, giant walking stick (an insect); Group 3: whale, human, giant fruit bat
Group 1: hummingbird, ostrich, bee; Group 2: whale, human, penguin; Group 3: giant walking stick (an insect), water strider bug, giant fruit bat
Group 1: penguin, water strider bug, whale; Group 2: ostrich, giant walking stick (an insect), human; Group 3: hummingbird, bee, giant fruit bat
Question 4
Polar bears from the Arctic do not produce offspring with the speckled bear of South America due to:
temporal isolation.
gamete incompatibility.
behavioral isolation.
spatial isolation.
Question 5
Which of the following statements BEST describes the current knowledge about Earth’s biodiversity?
It is relatively common for scientists to discover new or fossil organisms that are completely different from other organisms.
Most species that have existed on Earth are alive today.
There is uncertainty about the diversity within various species.
Scientists generally agree that most species have been identified.

Quantitative Article Review And Critique
Quantitative Article Review And Critique
By now, you should be aware that the findings from a research study are only part of the story. As a consumer, hoping to inform practice by use of an evidence base, you want to know much more. A sound research study includes all the steps highlighted in previous weeks: reviewing existing literature, focusing a research question, choosing a qualitative or quantitative method for answering the question, designing the study including selection of data collection procedures and/or measures, procedures used, data analysis plan, and findings. In addition, the study commonly discusses how ethical concerns were addressed and acknowledges the limitations of the study. For this assignment, you review a published research study with two purposes in mind:
Permalink:
Observing the structure and content of the article
Comparing the content of the article to the recommended content of sections for a research study By Day
Submit a 7-10 page critique and review of the article, which includes the title page and the reference list. Follow the guidelines below:
Use the quantitative or qualitative research article that you located and that your instructor approved as part of the Week 5 assignment.
Provide an APA reference for the article you select.
If you selected a quantitative research study, use the “Quantitative Article Review and Critique. If you selected a qualitative study, use the “Qualitative Article Review and Critique.” Respond to all the questions.
Be sure to include the questions in your critique. This will cause your Turnitin report to show high similarity to other students’ papers. However, do not be concerned about that. Do, however, appropriately paraphrase and cite specific details from the article you review.
By now, you should be aware that the findings from a research study are only part of the story. As a consumer, hoping to inform practice by use of an evidence base, you want to know much more. A sound research study includes all the steps highlighted in previous weeks: reviewing existing literature, focusing a research question, choosing a qualitative or quantitative method for answering the question, designing the study including selection of data collection procedures and/or measures, procedures used, data analysis plan, and findings. In addition, the study commonly discusses how ethical concerns were addressed and acknowledges the limitations of the study. For this assignment, you review a published research study with two purposes in mind:
Observing the structure and content of the article

Assignment: Termites And Pacific Lampreys
Assignment: Termites And Pacific Lampreys
Permalink:
This week our discussion is focused on animal evolution. For your primary post, respond to one of the following three topics. Also, please reply to at least one fellow student on any topic.
Topic 1
: Population Distribution of Termites in a Savanna. Watch the video (1) describing Corina Tarnita’s research on the spacing of termite mounds in savanna ecosystems, and then address the following:
(a) What were Tarnita’s findings about the spacing of termite mounds?
(b) What does Tarnita think is the main factor that governs the spatial distribution of the termite mounds?
(c) How do the termite mounds benefit other organisms on the savanna?
Topic 2
: Pacific Lampreys. Watch the video about Pacific Lampreys (2)*, then address the following:
(a) Where do Pacific lampreys fall in the taxonomy of vertebrates?
(b) What challenges do Pacific lamprey populations face?
(c) Why are Native American tribes of the Northwest concerned about them? (Please note: take care not to confuse the Pacific lamprey (described in the video) with the Sea Lamprey, which is a completely different species that is considered an invasive species in the Great Lakes).
Topic 3 [article]: Supporting the Energy Needs of a Large Brain. As discussed in the article by Zimmer (3)*, brain tissue is energetically expensive. For a species to evolve a large brain, it may need to make certain adjustments to ensure that enough energy is available to support brain function. Zimmer discusses various hypotheses about such adjustments in the human line of descent. Explain one of these adjustments.
References (in Strayer Writing Standards format).
HHMI Biointeractive (2015, November 11). Analyzing patterns in the savanna landscape. [Video]. Retrieved from
U.S. Fish & Wildlife Service. (2012). Taking the initiative to conserve Pacific Lamprey. [Video]. Retrieved from
Carl Zimmer, July/August 2011. The brain. Discover, 32 (6), 18-19.
Note: If you have trouble with the link to Carl Zimmer’s article, the following link is to a file with the text of the article:

Discuss: Patient Experiencing Esophageal Reflux
Discuss: Patient Experiencing Esophageal Reflux
Question 23
For the patient experiencing esophageal reflux, the nurse would expect which sphincter to be malfunctioning?
a. Pyloric
b. Lower esophageal
c. Upper esophageal
d. Gastric
Question 24
Cholecystitis is inflammation of the gallbladder wall usually caused by:
a. accumulation of bile in the hepatic duct.
b. obstruction of the cystic duct by a gall-stone.
c. accumulation of fat in the wall of the gallbladder.
d. viral infection of the gallbladder.
Question 25
A 6-month-old male infant is brought to the ER after the sudden development of abdominal pain, irritability, and vomiting followed by passing of “currant jelly” stool. Ultrasound reveals intestinal obstruction in which the ileum collapsed through the ileocecal valve and invaginated into the large intestine. This type of obstruction is referred to as:
a. Prolapse
b. Pyloric stenosis
c. Intussusception
d. Imperforation
Question 26
A 22-year-old male underwent brain surgery to remove a tumor. Following surgery, he experienced a peptic ulcer. His ulcer is referred to as a(n) _____ ulcer.
a. Infectious
b. Cushing
c. Ischemic
d. Curling
Permalink:
Question 27
Chronic gastritis is classified according to the:
a. severity.
b. location of lesions.
c. patient’s age.
d. signs and symptoms.
Question 28
Reflux esophagitis is defined as a(n):
a. Immune response to gastroesophageal reflux
b. Inflammatory response to gastroesophageal reflux
c. Congenital anomaly
d. Secretory response to hiatal hernia
Question 29
The cardinal signs of small bowel obstruction are:
a. Vomiting and distention
b. Diarrhea and excessive thirst
c. Dehydration and epigastric pain
d. Abdominal pain and rectal bleeding
Question 30
The nurse assessing the patient with biliary atresia would expect to find which primary clinical manifestation?
a. Anemia
b. Jaundice
c. Hypobilirubinemia
d. Ascites
Question 31
A 20-year-old male was recently diagnosed with lactose intolerance. He eats an ice cream cone and develops diarrhea. His diarrhea can be classified as _____ diarrhea.
a. Motility
b. Hypotonic
c. Secretory
d. Osmotic
Question 32
Which of the following symptoms would help a health care provider distinguish between ulcerative colitis and Crohn disease?
a. Pattern of remission/exacerbations
b. Abdominal pain
c. Malabsorption
d. Diarrhea
Question 33
A 45-year-old male complains of heartburn after eating and difficulty swallowing. He probably has:
a. Pyloric stenosis
b. Hiatal hernia
c. Gastric cancer
d. Achalasia
Question 34
The exocrine portion of the pancreas contains:
a. alpha cells.
b. beta cells.
c. acinar cells.
d. islets of Langerhans.
Question 35
Outbreaks of hepatitis _____ often occur in young children attending day care centers and can be attributed to poor hand washing.
a. A
b. B
c. C
d. D