AANP - Walden (Drugs), AANP - Walden (Evidenced Based Practice), AANP - Walden (Nursing Research Review), AANP - Walden (Professional Roles & Reimbursement), AANP - Walden (Ethical Guidelines & Adv Practice Law), AANP - Walden (Pediatrics), AANP QUESTIONS WITH 100% Accurate solutions +Rationales

Beta blockers

decrease heart rate and dilate arteries by blocking beta receptors

-lol

contraindicate in asthma/copd//emphysema, masks signs of hypoglycemia, bradycardia, exercise intolerance, fatigue

Calcium Channel Blockers (CCB)

slow calcium channels in myocardium.

promotes vasodilation.

highly protein bound. work better in AA.

do not use grapefruit

side effect is edema in ankles, arrhythmias, hypotension, headache, dizziness, constipation, flushing, weakness, migraine prophylaxis, drug reaction with grapefruit, preferred for isolated systolic hypertension

ARBs and ACEI

lower Hgb levels in pts with chronic diseases preferred in CHF/diabetes patients, asses renal function, avoid in renal stenosis, hypotension, hyperkalemia

Atorvastatin (Lipitor)

HMG-CoA Reductase Inhibitors (Statins)

perform liver function tests

side effect myalgias, myopathy, rhabdomyolysis.

Contraindicated with grape fruit juice

Thiazides

Diuretic prototype: block Na+/Cl− transporter in distal convoluted tubule; used in HTN, CHF, chronic stone formers.

Tox: K+ wasting; increased serum lipids, uric acid, and glucose

largest studied drug, lowers potassium, increases gout, increase digoxin toxicity

Spironolactone (Aldactone)

potassium-sparing diuretic; aldosterone antagonist

side effect of gynecomastia

Diuretic side effects

- decrease in Ca++ (except thiazides), Cl, K, Mg, Na

- metabolic alkalosis (loops)

- ototoxicity (loops)

- hyperuricemia

- hyperglycemia

- hyperlipidemia

- photosensitivity

Butterburr used for:

headaches

Ginko bilboa can help with

help with memory, circulatory disorders, contraindicated with aspirin/warfarin

Saw Palmetto uses

BPH

St John Wort used for?

depression & menopause symptoms

Kavakava/valerian root used for?

anxiety or insomnia affects liver

Ginseng used for?

reduce stress, weight loss, sexual dysfunction, lower blood sugars

Ginger used for

anti-inflammatory, nausea GI Upset

Feverfew used for?

migraines and menstrual cramps

Echinacea used for?

builds immunity

Aspirin used for?

effect on platelets irreversible 15- 20 days, monitor for bleeding, tinnitus, tarry stools, GI irritation

NSAIDs used for?

affect GI, renal, cardio, blunts diuretics

Ponstel (Mefenamic acid) uses

is an NSAID for menstrual pain

Macrobid/nitrofurantoin uses

long term use associated with lung, hepatitis, renal insufficiency, and neuropathy

Metformin uses

Oral, first line therapy in type 2 diabetes mellitus. Doesn't cause hypoglycemia.

affects liver enzymes, weight loss, avoid in alcohol drinkers, watch for lactic acidosis, diarrhea and flatulence

Steroids side effects:

-sone

side effects osteopenia, cataracts

Potentially inappropriate drugs for elderly:

Benadryl, glipizide, glyburide,

benzodiazepines, thioridazine, mesoridazine, Seroquel, Zyprexa, Elavil, trofanil,

NSAIDS, Ambien, Reglan, mineral oil, PPI's

Potentially inappropriate drugs for pregnant females:

Tetracyclines, sulfa is iffy, fluoroquinolones, ACE, NSAID, aspirin, any hormonal drugs, Accutane,

Loretta Ford

Co-developed 1st Nurse Practitioner in 1965.

Metanalysis is

combines data from multiple studies resulting in higher statistical power and single conclusion, gold standard for research evidence in EBM

Systematic review is

A rigorous summary of all research evidence related to a topic

literature review that identifies selects, analyzes research articles concerning health condition disease or practice

Randomized control trial-(experimental study)

subjects assigned to control or treatment group, experimental study (double blind design (no one know who is being treated)

Experimental study

experiment involves random subject selection, one placebo one controlled and one intervention, see above RCT

Quasi experiment

convenience sampling instead of random sampling

Cohort study

study that measures variables of a group of people over time

used to investigate risk factors of a disease, death or other conditions, subjects observed for long time, no intervention, goal is to find risk factors not causation (can be a prospective study of now to future))

Case report is

detailed report of one patient with disease or unusual condition, that includes demographics, signs symptoms, diagnosis, response to treatment

Case series is

series of case reports involve several individuals who are given similar treatment

Opinions/editorials are

biased and not based on solid evidence, weakest evidence

Sensitivity is

the ability of a test to detect a person who has the disease true positive

Specificity is

the ability of a test to detect a person who is healthy or detect the person without the disease true negative

Horizontal transmission

disease is spread through a population from one infected individual to another

Ex sex transmitting HIV

Vertical transmission

when a parasite is transmitted from a parent to its offspring

mother transmitting HIV to fetus

Endemic

confined to a particular country or area

baseline particular disease,

Epidemic

A widespread outbreak of an infectious disease.

rapid increase involving large number

Pandemic

worldwide epidemic

large are countries continents

Primary prevention

prevent disease or injury before it ever occurs (diet, exercise, gun locks, seatbelt, bike helmets, education eating well, OSHA, EPA, build youth center, habitat for humanity, aspirin who have risk , not smoking, immunizations)

Secondary prevention

reduce the impact of a disease by detecting or treating the disease to halt or slow progress (regular exams, screening tests, (paps, cbc, cage, interview for depression or sex partners, test for hep C) low dose aspirins exercise to prevent further attacks, modify work so injured people can work safely

Tertiary prevention

soften the impact of ongoing illness or injury lasting effects, manage long term effects of chronic illness/permanent impairments (cardiac stroke rehab, diabetes, depression, arthritis, support groups, vocational rehab

Control group

subjects in an experiment who do not receive treatment

Prospective study

studies done in the present to the future data obtained in present and periodically measured in the future

Retrospective study

(ex post facto) studies done on events that have already occurred(chart reviews, recall of events

Longitudinal study

long term study that follows same group or subjects over many years to observe measure and compare same variables over time Ex. Framingham Heart study followed group to monitor CVD

Cohort study

group individuals share common characteristics such as gender job, ethnicity, studying causative factors or risk factors Ex study of nurse's long term who taken oral contraceptives

Cross sectional study

compares differences and similarities between two or more groups of people or phenomena and collects data at one point in time

Case control study

in depth investigation of a single person, group or phenomena

Experimental study

use randomization with subject selection

Correlational studies (observational)

search for relationship between minimum

of two variables

Deductive logic

used in quantitative studies

Inductive used in:

qualitative studies

Institutional review boards IRB's

ensure rights, safety and welfare of human

research subjects, purpose to protect the rights of human subjects enrolled in a study

Normal curve

is the bell curve

N stands for

total number of subjects

n =

subgroup

State nurse practice act is:

"right to practice"enacted into law by state legislature

State board of nursing is:

responsible for forcing state nurse practice act

Title protection is:

titles protected by law

Standard of profession nursing practice:

developed by professional societies

Collaborative practice agreements are

written agreement between supervising physician and NP

Situational Leadership Theory

a contingency theory that focuses on followers' readiness

flexible, can adjust his or her leadership style

Transformational leadership Theory

a leadership style that empowers group members to work independently from the leader by encouraging group cohesion

ability to communicate vision to staff

Laissez-Faire Leadership

allows the group to function more or less on its own

minimal supervision or direction of staff

Authoritarian Leadership

focuses on instrumental concerns, takes personal charge of decision making, and demands that group members obey orders

like control and structure

Democratic leadership

A form of leadership in which the leader solicits input from subordinates.

likes more staff meeting for input from staff

Servant leadership

focuses on increased service to others rather than to oneself

likes to work along staff

Malpractice

professional negligence

duty is owed, duty was breached, breach caused injury, damage occurred

Problem focus visit is:

chief complaint, HPI, no ROS or past family/social history needed

NPI (National Provider Identifier)

a standard identifier for healthcare providers consisting of ten numbers

ICD-10 codes are

alphanumeric

diagnosis codes

CPT codes

billing codes for medical, surgical and diagnostic services

"Incident to" billing

billing is used for Medicare patients and refers to billing follow up visit performed by non-physician provider billed under physicians NPI#, nonphysican is paid 100% vs the rate of an NP who receives 85%

Insurance

considered third party

Beneficence (Definition)

Maximize possible benefits and minimize possible harms.

obligation to help patient, to remove harm, to prevent harm, promote good, "do no harm"

Ex. Educating patient about new prescription, how to take, encourage to stop smoking, calling surgeon to get prescription stronger

Nonmalificence (definition)

do no harm

obligation to avoid harm, protect a patient from harm, prescribing a medication that is not contraindicated to patient

Utilitariasm

obligation to act in way that's useful to or benefits the majority, outcome is what matters with utilitarism, use resource to benefit the most

EX: WIC is only for women and babies because it would cost society more if these patients were hurt by inadequate food intake.

Justice (definition)

quality of being fair without acting with a lack of bias, fair suitable distribution of resources

EX: homeless man admitted to ED without insurance, treated the same as a man with insurance

Dignity (definition)

quality or state of being worthy of ethical and respectful treatment respect for human dignity is important aspect of medical ethics, persons religious, personal, cultural beliefs are considered dignified treatment

Ex. Using hospital gowns to cover patient front and back, Foley catheters should not be visible to visitors not to embarrass patient

Fidelity (definition)

obligation to maintain trust in relationship- keeping promise, dedication and loyalty to patient

Ex. NP should try her best to develop trust with patient

Confidentiality (definition)

obligation to protect patient's identity, personal information, test results, medical records, conversations, and other health information is right is protected by HIPPA

Autonomy (definition)

obligation to ensure mentally competent patients have right to make their own health decisions and express treatment preferences

Accountability (definition)

NP are responsible for their own actions and choices and do not blame others for their mistakes

Ex. Patient diagnosed with pleurisy but when goes to ED is diagnosed with MI, no error is held accountable for her decision

Veracity (definition)

obligation to present information honestly and trustfully, in order for patient to make informed decision, do not withhold "bad news"

Ex. Patients mammogram results are in, but son does not want patient to know, no must tell patient

Paternalism (definition)

one person interferes or overrules the autonomy of another

Ombudsman (definition)

person who acts as intermediary between patient and organization

ombudsman investigates and mediates complaint form both sides and attempts to reach fair conclusion

Guardian ad litem (definition)

person assigned by court to act in best interest of the child/frail vulnerable patient.

TPA (definition)

organization that does processing of claims and administrative paperwork for another company

Medicare Part A:

pays for inpatient services, (Hospice)

Medicare Part B:

pays for outpatient services (ambulance emergency only)

Medicare Part C:

pays for both A & B

Inpatient and outpatient services

Medicare Part D:

is for medications drug benefit

Medicaid

provides insurance for low income individuals and families who meet poverty criteria

HMOs

Health maintenance organizations

patients assigned PCPC (gatekeeper),copay per visit, PCP must approve referral

PPOs

Preferred Provider Organizations

not assigned PCP, can visit any PCP, more expensive than HMO

Medicare Part B does NOT cover

does not reimburse for dentures glasses or hearing aids or ambulance transportation

COBRA is a federal law:

law that allows person to keep insurance after quit job