HLTB21H3 Midterm: Midterm Notes.docx
You are a researcher working on a treatment for Hutchinson-Gilford progeria syndrome, an extremely rare genetic disorder that causes accelerated aging in children. Children with progeria generally appear healthy at birth but soon start growing more slowly than other children and lose their hair. Additional symptoms include stiffness of joints, heart problems, and stroke. These children typically die of heart disease at an average age of 13 years.
Progeria is caused by a mutation in a single gene, called lamin A. Scientists have identified over 1,400 mutations in the lamin A gene that result in changes in transcription, RNA splicing, and/or protein production. Lamin A codes for a protein required for the structural support of the nuclear envelope in cells. Without a functional protein, the nuclear envelope becomes unstable, eventually damaging the nucleus and causing cells to die.
Based on what you learned in this Click & Learn, propose a genetic medicine strategy you could develop to treat patients with progeria. Describe which step in gene expression you might target and why you would target that step, the intervention tool you would use, and explain how this strategy would treat the disease
Q37 Research indicates more than 90 % of the deaths occur in older adult 65 and older due to lack of appropriate immunizations on which annual vaccination should the nurse first instruct the patient?
Q38 which strategies of care would be least likely to enhance the physical function of older adult choose? Choose 2 answers
A weight control
B hearing and vision screening
C smoking cessation
D illness management
E forcing them to attend all activities
Q39 what are common risk factors that contribute to functional decline in the older adult population?
A physical inactivity
B tobacco use
C low sodium dietary intake
D having small families
Q40 what principle is least related to promoting health and preventing certain disabilities in older adults?
A continue activities of daily life (ADLs)
B Maintain as active a lifestyle as possible and desired
C Monitor illnesses through annual health screening ( AHS)
D keep up on assistive and information technology and other tools
Q41 Which focusing on the psychosocial needs of older adults, authorVirginia satir recommends that Healthcare providers get back to the basic communication. whatare the five basic principles satir describes?
B follow through
C respect personal space
D maximize understanding
E Arrange environment
F maximize attention levels
H maximize communication
Q42 how do electronic health records facilitate better care coordination? Choose 2 answers
A saving time typing rather than writing
B increasing the accuracy of diagnosis and health outcomes
C preventing an increase in the number of medical errors
D improving communication among health providers
Q43 Rick a 91 year old male, hasa history of chronic otitis media and is experiencing mild hearing loss in hisright ear,what type of assistive technology would Rick use to improve communicative function?
A icon communication board
B behind the ear ( BTE) hearing aid
C Augmentive and alternative communication ( AAC)
D completely in the canal ( CIC) hearing aid
Q 44 An elderly patient has suffered a stroke and is currently in the process of transitioning out of the hospital and into an assisted living facility. The patient's primary diffulty after the stroke is dealing with dysarthria, whichhas limited the patient's ability to speak. whatcommunication technology would appropriately promote an optimal transition of care for the patient?
A an over the ear (OTE) hearing aid
B an augmentation and alternative communication ( AAC) device
C an assistive listening device ( ALD)
D an analog technology to amplify sound
Q45 what must the nurse inform the patient and family or caregivers about assistive devices? Choose 2 answers
A may lessen the importance of ongoing communication with healthcare providers.
B they may result in complete recovery from chronic illness
C they may limit complications of an illness or disability.
D they may enable independent performance and reduce risk of injury.
Q46 An 81 year old Patient has multiple chronic conditions including uncontrolled hypertension and peripheral artery disease and agrees to try assertive devices for monitoring blood pressure and improving circulation provided by a home health agency. Choose 2 answers
A allowing the patient enough time and opportunity for repetition
B only presenting the most relevant content to the patient.
C refraining from suggesting mnemonic devices to Aid the patients use of Technology
D having an outside educator provide several hours of detailed device instructions
Q47 A goal of the National Health Initiative healthy people 2010 is to increase the quality and extend the years of healthy life. What are two ways that this initiative can achieve its goal? Choose 2 answers
A by pressuring older adults who are lonely to move to nursing homes at younger ages
B By encouraging people to have more children so that the children can help their parents as they grow older
C by helping people overcome views of denial and foreboding as old age approaches
D by trying to spread the view that aging is natural and need not include illness and disease
Q48 match each government program with its description. Answer options may be used more than once or not at all
A provide health insurance for low-income families
B bases basic benefits on a workers average indexed monthly earnings in covered employment
C offers a payment system for long-term care ( LTC) foreligible older Americans and persons with disabilities
D is the health insurance program for those 65 or other people with disabilities
Q49 a senior is being cared for by her daughter. The daughter works a full-time job and is only able to care for her mother before she goes to work. On her lunch break, andafter she gets off work. thesenior expresses to a nurse that she gets lonely during the day and sometimes cannot perform tasks by herself.which community resource should the nurse recommend looking into?
A a local Health Clinic
B Day Care Services for Seniors
C a medication assistance program
D Meals on Wheels.
Q50 the Independence at home demonstration was created by the Affordable Care Act. Which statement is true regarding Primary Care teams participating in this initiative?
A the teams are led by a licensed administrator
B the teams must serve at least 500 Medicare beneficiaries.
C the teams be led by a physician.
D the teams can be lead by a nurse practitioner.
Q51 which important facts about Medicare should nurses know? Choose 2 answers
A Medicare requires income assessment in order to qualify for coverage
B Medicare cover assisted living services for Americans in extreme poverty.
C Medicare recipients range from those simply needing Wellness services to those who are profoundly Frail.
D Medicare covers certain disabled Americans who have not reached age eligibility.
Q52 what is a common preventable error that can occur during the transition of care for older adults?
A unhelpful Hospital staff B inaccurate medication reconciliation.
C disorganized dosing schedule
D lost nursing equipment.
Q53 how is communication further facilitated? Choose 2 answers
A through communication to between and among the patients family caregivers and health care providers
B through active engagement of patients and family caregivers with a focus on meeting the patients goals
C through reliance on use of text messages that are less disruptive to the patient and family.
D through Healthcare Providers conversing with the patient and allowing the patient speak with the family.
Q54 what are appropriate evaluation measures related to successful transitions of care? Choose 2 answers
A emotional and social domains of quality of life.
B all clinical indicators related to Chronic conditions.
C functional status
D exclusion of nursing sensitive measures.
Q55 a critical competency in geriatric nursing is the ability to assess family knowledge of the skills necessary in the care of older adults. What Broad caregiver competencies are included in this assessment?
A knowing the science behind the scenes of geriatrics
B allowing the active participation of the patient in all aspects of care.
C balancing the patient autonomy with safety
D knowing how to safely start an IV.
Q56 what Communications techniques promote safe transition of care in patients with aphasia?
A respond in the affirmative when a question is asked
B speak softer so as to never have a harsh tone
C give the patient time to speak
D use non-verbal gestures to communicate.
Q57 what roles of the nurse protect the patient from harm in a care transition?
A symptom manager,educator, collaborator, carecoordinator.
B medication manager screener educator listener
C liasson with Hospital decision maker collaborator coordinator
D decision maker Symptom Manager care coordinator.
Q58 which statements are true regarding health-related quality of life? Choose 2 answers
A cannot be measured in persons with chronic illness
B is measured by and object Observer, basedon the number of times an individual emits both verbal signs of happiness and well-being
C is measured by individuals perceived healthy days per month.
D can be measured by an instrument developed by the center of Disease Control (CDC)
Q59 several options are available as a care approaches to chronic illness care. Which method best describes palliative care?
A care that is only delivered by family or other personal caregivers
B end-of-life care that suspends active treatment
C a combination of active treatment and comfort measures
D a continued focus on here rather than comfort and quality of life.
Q60 A nurse caring for people at the end of their lives knows that Dysnea is relatively common and interferes with patients'comfort and rest. What is the evidence based intervention for shortness of breath?
A liquid morphine at starting dose of 10 mg every 4 hours and titrating dose upward until dyspnea is relieved.
B administer O2 at least 5 liters per minute
C 5 mg of liquid morphine every 4 hours,along with lorazepam 0.5-2.0 mg every 4-6 hours PRN for anxiety and restlessness.
D elevate the head of the bed no more than 20 degrees.
Q61 what do dying persons typically experience grief over?
A loss of bodily function and independence that occurs as illness becomes more prevalent
B loss ability to give and receive love
C loss of basic beliefs,values and faith.
D the feeling that nobody cares that the person is dying.
Q62 which of the following is often the biggest barrier to overcome in crucial conversations to death and dying?
A mistrust of healthcare providers
B lack of energy
C societal attitudes about death
D cost of care
Q63 The End of life Nursing Education consortium (ELNEC) is a resource targeted to nurse providing end of life care that supports evidence based care of dying patients and their families,as well as self care that lessens stress and anxiety and sustains nurse in providing excellent end of life care. Which of the following are self care principles? Choose 2 answers
A maintaining professional boundaries and relationships with patients and families, by tightly controlling feelings and empathy
B. Making good use of the expertise and support of the interprofessional care team
C. Diminishing attention on maintaining an active personal life since end-of-life care is a callings of sorts
D. Developing expertise in symptom management, which not only helps patients and their families, but increases satisfaction and lessens anxiety among professional caregivers
Q64. In addition to a living will, advanced directives may also include a durable power of attorney that encompasses health care related decision making. Which two of the following are accurate so statements regarding the legal instrument known as the durable power of attorney?
A. The alternative decision maker must be a close relative of a dying persons in order to understand his or her wishes.
B. It allows for an alternative decision maker in the event that the dying persons is incapacitated and no longer able to make health care decision
C. The living will remains a useful tool in providing direction to the alternate decision maker.
D. A durable power of attorney for health care decision also enables the alternative decision maker to also handle finances and other legal matters.
Each of the following paragraphs presents a study objective and the methodology that will be used to evaluate the types of epidemiologic study design. State what is the study design for each study? (24 points â 4 each) (Note: For study design, try to have as detailed design as possible and avoid simply âexperimental studyâ or âobservational studyâ)
c) The following abstract was obtained from PubMed (with modification by XLD).
Lishman H, et al. Exploring the relationship between primary care antibiotic prescribing for urinary tract infections, Escherichia coli bacteraemia incidence and antibiotic resistance. Int J Antimicrob Agents. 2018 Aug 23. [Epub ahead of print].
This study aimed to quantify the association between antibiotic prescribing for urinary tract infections (UTIs) and the incidence/antibiotic susceptibility of UTI-related Escherichia coli bacteraemia in adult women in England. A national study was conducted with data aggregated at the GP practice level. The study population was all adult female patients (18+) with a reported UTI-related E. coli bacteraemia in England (2012-2014). Reports of bacteraemia from the national mandatory surveillance scheme were linked with E. coli blood culture susceptibility data (where available) and the correlation with primary care exposure to trimethoprim and nitrofurantoin was quantified using longitudinal multi-level models. There were 20,274 patients in the study from 5,916 practices. Between 2012-2014, the overall incidence of UTI-related E. coli bacteraemia in the study group did not change significantly (1.3% increase, 95% CI 0.1%-2.7%, p=0.074). However, after adjusting for practice characteristics, UTI-related E. coli bacteraemia incidence increased by 3.0% and 1.5% with each increasing quintile in trimethoprim and nitrofurantoin prescribing, respectively. The incidence of trimethoprim-resistant bacteraemia increased by 4.5% (p=0.032) with each increasing quintile in trimethoprim prescribing and was not associated with nitrofurantoin prescribing. This study demonstrates an association between GP prescribing for UTIs and UTI-related E. coli bacteraemia incidence at the practice level and shows that higher prescribing of trimethoprim is associated with higher incidence of trimethoprim-resistant bacteraemia. Evidence is provided of the importance of prudent antibiotic prescribing in primary care to prevent the development of antibiotic resistance which can put patients at risk of subsequent severe infections.
Study Design: ___________________________
d. The following abstract was obtained from PubMed (with modification by XLD).
Mubarak MY, et al. Hygienic practices and diarrheal illness among persons living in at-risk settings in Kabul, Afghanistan. BMC Infect Dis. 2016 Aug 31;16(1):459.
BACKGROUND: Sustained civil and military conflict, resulting in large numbers of internally displaced persons (IDP), in combination with rapid urbanization has strained public health and sanitation within cities in Afghanistan. In order to examine the association between preventive sanitary behaviors and diarrhea within two high risk settings located within Kabul, Afghanistan, this study aimed to evaluate the prevalence of hygienic practices and diarrheal illness in an IDP camp and an urban slum.
METHODS: In this study, a convenience sample of residents of an IDP camp and an urban slum in Kabul, Afghanistan, was used. Participants were asked to describe their hygienic practices and interviewers independently documented household sanitation. The knowledge and attitudes about and practice of hygienic activities to prevent diarrhea were compared between the two settings.
RESULTS: Two hundred participants, 100 from each setting, were enrolled. Knowledge, attitudes, and practices regarding hygienic activities to prevent diarrhea were greater among the slum dwellers than the IDP. Fewer than half of participants washed their hands with soap before eating or after eating: 31 % of slum dwellers washed before eating compared to 11 % of IDPs (Pâ=â0.0050), and 25 % of slum dwellers washed after defecating compared to 4 % of IDPs (Pâ=â0.0020). The IDPs were more likely to share a latrine (Pâ=â0.0144) and less likely to disinfect their latrine than slum dwellers. Diarrhea in the household within the past 3 months was more common in the IDP camp (54 %) than the slum (20 %) (Pâ=â0.0020).
CONCLUSIONS: Even though certain sanitary and hygienic practices were more common among slum dwellers than IDPs, the lack of hygienic activities in both setting indicates that interventions to change behavior, like increasing the availability of soap and encouraging hand washing, are needed. Any initiative will have to be developed in the context of pervasive illiteracy among persons in these settings.
Study Design: ___________________________