NURS-6630N-35,Approaches to Treatment

 

QUESTION 1

1. Richard is a 54-year-old male who suffers from schizophrenia. After exhausting various medication options, you have decided to start him on Clozapine. Which of the statements below is true regarding Clozapine?a.Regular blood monitoring must be performed to monitor for neutropenia.b.Clozapine can only be filled by a pharmacy that participates in the REMS program.c.Bradycardia is a common side effect of Clozapine.d.A & Be.All of the above

3.75 points   

QUESTION 2

1. Which of the following statements are true?a.First-generation (typical) antipsychotics are associated with a higher incidence of EPS.b.Second-generation (atypical) antipsychotics are associated with a higher risk of metabolic side effects.c.There is evidence that atypical antipsychotics are significantly more effective than typical antipsychotics in the treatment of cognitive symptoms associated with schizophrenia.d.A & Be.A, B, and C

3.75 points   

QUESTION 3

1. Cindy is a 55-year-old patient who presents with symptoms consistent with Generalized anxiety disorder. The patient has an unremarkable social history other than she consumes two or three glasses of wine per night. Which of the following would be an appropriate therapy to start this patient on?a.Xanax 0.25mg BID PRN Anxietyb.Escitalopram 10mg dailyc.Buspirone 10mg BIDd.Aripiprazole 10mg daily

3.75 points   

QUESTION 4

1. Mirza is a 75-year-old patient with a long history of schizophrenia. During the past 5 years, she has shown significant cognitive decline consistent with dementia. The patient has been well controlled on a regimen of risperidone 1mg BID. As the PMHNP, the most appropriate course of action for this patient is:a.Increase the risperidone to 1mg QAM, 2mg QPMb.Discontinue risperidone and prescribe a long-acting injectable such as Invega Sustenna.c.Discontinue risperidone and initiate therapy with clozapine.d.Augment the patient's risperidone with brexpiprazole.

3.75 points   

QUESTION 5

1. The patient in the previous question states, "I can't even last 1 more day without feeling like my insides are going to explode with anxiety." The most appropriate course of action would be:a.Inform the patient to try yoga or other natural remedies until the vortioxetine takes effect.b.Prescribe a short-term course of low dose benzodiazepine, such as alprazolam.c.Prescribe an SNRI, such as venlafaxine, in addition to the vortioxetine.d.Recommend in-patient mental health for the foreseeable future.

3.75 points   

QUESTION 6

1. Thomas is a 28-year-old male who presents to the clinic with signs and symptoms consistent with MDD. He is concerned about starting antidepressant therapy, however, because one of his friends recently experienced erectile dysfunction when he was put on an antidepressant. Which of the following would be the most appropriate antidepressant to start Thomas on?a.Vilazodoneb.Sertralinec.Paroxetined.Citalopram

3.75 points   

QUESTION 7

1. Stephanie is a 36-year-old female who presents to the clinic with a history of anxiety. Social history is unremarkable. For the last 4 years, she has been well controlled on paroxetine, however she feels “it just doesn't work anymore.” You have decided to change her medication regimen to vortioxetine 5mg, titrating up to a max dose of 20mg per day based on tolerability. The patient asks, “When can I expect this to start kicking in?” The best response is:a.3 or 4 daysb.1 or 2 weeksc.3 or 4 weeksd.10 weeks

3.75 points   

QUESTION 8

1. Jane is a 17-year-old patient who presents to the office with signs consistent with schizophrenia. She states multiple times that she is concerned about gaining weight, as she has the perfect prom dress picked out and she finally got a date. Which of the following is the least appropriate choice to prescribe Jane?a.Aripiprazoleb.Olanzapinec.Haloperidold.Brexpiprazole

3.75 points   

QUESTION 9

1. John is a 41-year old-patient who presents to the clinic with diarrhea, fatigue, and recently has been having tremors. He was diagnosed 19 years ago with bipolar disorder and is currently managed on Lithium 300mg BID. As the PMHNP, you decide to order a lithium level that comes back at 2.3mmol/l. What is the most appropriate course of action?a.Investigate other differential diagnoses for his symptoms.b.Tell John to skip his next four Lithium doses and resume therapy.c.Tell John he needs to go to the hospital and call an ambulance to bring him.d.Prescribe loperamide to treat the diarrhea and ropinirole to treat the tremors

3.75 points   

QUESTION 10

1. Jordyn is a 27-year-old patient who presents to the clinic with GAD. She is 30 weeks pregnant and has been well controlled on a regimen of sertraline 50mg daily. Jordyn says that "about once or twice a week my husband really gets on my nerves and I can't take it." She is opposed to having the sertraline dose increased due to the risk of further weight gain. You have decided to prescribe the patient a short-term course of benzodiazepines for breakthrough anxiety. Which of the following is the LEAST appropriate benzodiazepines to prescribe to this patient?a.diazepamb.alprazolamc.clonazepamd.lorazepam

3.75 points   

QUESTION 11

1. Rebecca is a 32-year-old female who was recently prescribed escitalopram for MDD. She presents to the clinic today complaining of diaphoresis, tachycardia, and confusion. The differential diagnosis for this patient, based on the symptoms presenting, is:a.Panic disorderb.Gastroenteritisc.Abnormal gaitd.Serotonin syndrome

3.75 points   

QUESTION 12

1. Mark is a 46-year-old male with treatment-resistant depression. He has tried various medications, including SSRIs, SNRI, and TCAs. You have decided to initiate therapy with phenelzine. Which of the following must the PMHNP take into consideration when initiating therapy with phenelzine?a.There is a minimum 7-day washout period when switching from another antidepressant to phenelzine.b.Patient must be counseled on dietary restrictions.c.MAOIs may be given as an adjunctive therapy with SSRIs.d.A & Be.All of the above

3.75 points   

QUESTION 13

1. Melvin is an 89-year-old male who presents to the clinic with signs/symptoms consistent with MDD. Which of the following would be the LEAST appropriate medication to prescribe to this elderly patient?a.nortriptylineb.amitriptylinec.desipramined.trazodone

3.75 points   

QUESTION 14

1. Earle is an 86-year-old patient who presents to the hospital with a Community Acquired Pneumonia. During stay, you notice that the patient often seems agitated. He suffers from cognitive decline and currently takes no mental health medications. Treatment for the CAP include ceftriaxone and azithromycin. The LEAST appropriate medication to treat Earle's anxiety is:a.sertralineb.duloxetinec.citalopramd.venlafaxine

3.75 points   

QUESTION 15

1. Martin is a 92-year-old male who presents to the clinic with signs/symptoms consistent with MDD. The patient suffers from glaucoma and just recently underwent surgery for a cataract. Which of the following is the LEAST appropriate course of therapy when treating the MDD?a.sertralineb.amitriptylinec.duloxetined.vilazodone

3.75 points   

QUESTION 16

1. Sam is a 48-year-old male who presents to the clinic with signs and symptoms consistent with GAD & MDD. Which of the following medications would be the LEAST appropriate choice when initiating pharmacotherapy?a.duloxetineb.sertralinec.mirtazapined.buproprion

3.75 points   

QUESTION 17

1. Steve is a 35-year-old male who presents to the primary care office complaining of anxiety secondary to quitting smoking cold turkey 2 weeks ago. The patient has a 14-year history of smoking two packs per day. The patient has an unremarkable social history other than a recent divorce from his wife, Brittany. Which of the following would be the LEAST effective medication to treat Steve's anxiety?a.Buproprionb.Sertralinec.Vareniclined.Alprazolam

3.75 points   

QUESTION 18

1. Amber is a 26-year-old female who presents to the clinic 6 weeks postpartum. The patient states that she has been "feeling down" since the birth of her son. She is currently breastfeeding her infant. You diagnose the patient with Postpartum depression. Which of the following is the LEAST appropriate option in treating her PPD?a.paroxetineb.escitalopramc.citalopramd.sertraline

3.75 points   

QUESTION 19

1. Which of the following medications, when given intramuscularly, is most likely to cause severe postural hypotension?a.haloperidolb.lorazepamc.benztropined.chlorpromazine

3.75 points   

QUESTION 20

1. Jason is a 6-year-old child whose mother presents to the clinic with him. The mother says that “he's not himself lately." After a thorough workup, you diagnose the patient as having GAD. Which of the following medications would be the LEAST appropriate to prescribe to this child?a.Sertralineb.Paroxetinec.Venlafaxined.Buspirone

Research Article Critique, Part Two (Dey, 2016)

 

Instructions:  A major skill that is learned in this course is how to critically read and critique nursing research articles.  The purpose for critiquing an article is to critically evaluate the research process followed by the author(s) of the assigned article. This is an information-intensive, time-intensive process that is not learned overnight.   To demonstrate your skill at critiquing an article, you will complete this open-book multiple choice assignment.

 

Here's how you should approach completing this week’s assignment to finish critiquing an article:

 

1.  First, do your assigned reading in Grove & Gray (2019) and complete the reading worksheets early in the week.  This will introduce you to the critique skills you will need for the week.

 

2.  Skim the entire instructor assigned research article that has been posted on Blackboard for you so that you will have an idea of what it is about.  Lightly cross out the abstract for the article (you won't be using it). Then, for this week, re-read carefully from the study’s methods section through the end of the article.

 

3.  Print this document and find the best answer to each question below based on your assigned reading for the week and what you have read in the instructor assigned research article.

 

4.  Some of the questions in the critique assignment below will seem unfamiliar to you. Look up key terms from the question in your textbook.  Some examples of these terms might be: power analysis, inter-rater reliability, and generalization. You can also look in Chapter 12 for an example of a critical appraisal (or critique) of a quantitative research article.

 

5. Once you have completed this assignment “on paper”, go into blackboard and enter your answers by the assignment due date and time listed in the syllabus.  Ignore any wording from Blackboard that indicates that “this is a test” and carefully enter your answers from this document. 

 

6.  You will have two access attempts to record your answers.  This is given to you so that if you encounter technical difficulties on your first attempt, or you would like a second attempt to try to improve your grade, you may do so.  You will not be able to see the questions that you missed when you submit your attempt.  Blackboard will record the highest grade from the two submissions.

 

If you have questions about this assignment, you can post them to your group discussion board for help.  Please do not post the exact question from the assignment below and ask the group for the answer as this would constitute academic dishonesty.

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

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

a. Simple random sampling

b. Systematic sampling

c. Convenience sampling

d. Network sampling

 

2. According to Grove & Gray (2019), what are the potential biases of this sampling method?

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

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

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

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

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

 

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

a. 180 participants

b. 115 participants annually

c. 82 participants per month

d. 28 participants

 

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

a. The authors mention that a power analysis was conducted using a power of 0.8, an alpha value of 0.5, and a moderate effect size.

b. The authors mention that a power analysis was conducted, and 90 participants were needed for each group.

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

d. The authors mention that a power analysis was conducted using a power of 0.8, and alpha value of 0.5, and a strong effect size.

 

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

a. Participants were able to understand English.

b. Participants were able to read and write.

c. Participants were patients on the telemetry unit or the ACE unit.

d. Participants were scheduled to be discharged.

 

 

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

a. Participants could not complete the survey forms.

b. Participants were less than seventy years old.

c. Participants had delirium or dementia.

d. No exclusion criteria were specifically reported by the authors.

 

 

7. What is the acceptance rate for this study?

a. 100%

b. 182/180 X 100% = 99%

c. 2/180 X 100% = 1%

d. unknown / cannot be calculated

 

 

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

a. 1/78 X 100% = 1%

b. 0%

c. 77/78 x 100% = 98%

d. unknown / cannot be calculated

 

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

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

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

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

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

 

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

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

a. The Katz Index of Activities of Daily Living

b. The Pearlin Stress Process Model

c. The Bandura Self-Efficacy Scale

e. Clinical Skills Self-Efficacy Scale

 

 

11. How do the authors describe the CURRENT reliability of the Caring Behaviors Inventory for Elders (CBI-E)?

             a. They allowed the participants to complete the scale in a location of their own choice.

b. They reported a Cronbach’s alpha level of 0.94.

c. They tested the current group of subjects using two different versions of the same scale (alternate forms reliability).

d. They computed a Cronbach's alpha on a modified version of the scale that was administered to this group of subjects.

 

12. How do the authors describe the validity of the Caring Behaviors Inventory for Elders (CBI-E) used in this study?

a. The Caring Behaviors Inventory for Elders (CBI-E) scale was reviewed by six experts prior to being used in this study.

b. The Caring Behaviors Inventory for Elders (CBI-E) was examined by face, construct, and discriminant validity methods.

c. The Caring Behaviors Inventory for Elders (CBI-E) was described as having construct validity.

d. The Caring Behaviors Inventory for Elders (CBI-E) readability levels were identified prior to being used in this study.

 

13. What types of questionnaires or surveys were used in this research study?

a. The authors developed the Caring Behaviors Inventory for Elders (CBI-E).

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

c. Interviews were reportedly used, but the author does not explain what was included in them.

d. The authors developed their own questions to assess functional status.

 

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

a. Yes

b. No

 

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

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

a. Participants were contacted by phone by nurse researcher.

b. Primary unit nurses obtained participants’ Katz Index of Activity of Daily Living scores on admission and discharge.

c. Questionnaires / surveys were mailed to the prospective returned in a self-addressed stamped envelope.

d. Researchers consented participants after face to face discussion of study.

 

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

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

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

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

 

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

17. What descriptive statistics were NOT reported in this study?

a. mean

b. median

c. frequencies

d. kurtosis

 

18. Which one of these inferential statistics were NOT used to examine the data obtained from the participants?

a. Pearson correlation

b. Spearman rho

c. Multiple regression

d. Chi square

 

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

a. .01 or 1%

b. .05 or 5%

c. .10 or 10%

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

 

 

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

20. Which statement from the article would be considered a significant result?

a. In this study, the summed CBI-E score (M = 72.07, SD = 6.78) indicated that the total population of subjects (elders; n = 180) perceived high levels of caring.

b. Among total respondents (n = 180), 154 subjects (85.6%) experienced no decline, 26 (14.4%) experienced decline.

c. There is a postive correlation between elders’ perceptions of nurse caring behavior and functional status.

             d. There is a positive correlation between elders’ perceptions of nurse caring behavior and satisfaction with care.

             

21. Which one of these statements from the article would be considered a non-significant result?

a. The percentage of elders who declined on the ACE unit was higher than on the telemetry unit.

b. There was a positive correlation between elders’ perceptions of nurse caring behavior and satisfaction with care.

c. There was a negative correlation between elders’ perceptions of nurse caring behavior and satisfaction with care.

             d. The regression model of type of unit and nurse caring models predicting satisfaction of care explained 24% of the variance of elders’ satisfaction with care.

 

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

             a. Among total respondents (n = 180), 154 subjects (85.6%) experienced no decline, 26 (14.4%) experienced decline.

            b. There was a negative correlation between elders’ perceptions of nurse caring behavior and satisfaction with care.

            c. In this study, the summed CBI-E score (M = 72.07, SD = 6.78) indicated that the total population of subjects (elders; n = 180) perceived high levels of caring.

            d. In this study, elders 70 and older were satisfied with nursing care when they perceived caring nursing behaviors.

                       

23. Which statements below, as reported by the author, would be considered a limitation of the study?

a. The instrument CBI-E had not been tested previously in a hospital setting.

b. In this study acutely ill hospitalized elders reported that nurses demonstrated caring behaviors, and they were satisfied with nursing care.

c. Elder care is complex, a specialty that requires specialized education.

d. The interaction of nurse caring behaviors (predictive variable) and type of unit (moderator) was neither associated with nor did it predict satisfaction with nursing care.

 

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

a. The sample lacked cultural and racial diversity.

b. The instrument CBI-E had not been tested previously in a hospital setting.

c. Elder care is complex, a specialty that requires specialized education.

d. In this study acutely ill hospitalized elders reported that nurses demonstrated caring behaviors, and they were satisfied with nursing care.

 

25. Which of these statements from the article would be considered a recommendation for future studies?

 

a. The interaction of nurse caring behaviors (predictive variable) and type of unit (moderator) was neither associated with nor did it predict satisfaction with nursing care.

b.  Additional research is needed to identify the factors that contribute to the functional decline of hospitalized elders.

c. Although there was no unit difference in subjects’ functional status decline, the overall rate of functional decline (14.4%) was lower than the 33% in previous studies.

             d. Teaching elder care in new-nurse orientation might improve nurse caring behaviors that lead to satisfaction and care quality.

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