Module 2 Buttaro Ch 4,7, 9-15, 16-21 Flashcards
(43 cards)
To reduce adverse events associated with care transitions, the Center for Medicare and Medicaid Service have implemented which policy?
a. Mandates for communication among primary caregivers and hospitalists
b. Penalties for failure to perform medication reconciliations at time of discharge
c. Reduction of payments for patients readmitted within 30 days after d/c
d. Requirements for written discharge instructions for patients and caregivers
c. Reduction of payments for patients readmitted within 30 days after d/c
Patients with chronic health problems are at risk for adverse events related to the fact that they see so many providers which causes increase in hospital admissions and cost to patients.
MAJORITY OF THE TIME IT IS DUE TO POOR COMMINICATION BETWEEN PROVIDERS AND IS PREVETABLE
According to multiple research studies, which intervention has resulted in lower costs and fewer rehospitalizations in high risk older patients?
a. Coordination of posthospital care by advanced practice health providers
b. frequent posthospital clinic visits with a primary care providers
c. Inclusion of extended family members in the outpatient plan of care
d. telephone follow up by the pharmacist to asses medication compliance
a. Coordination of posthospital care by advanced practice health providers
Research studies provided evidence that high risk older patients who had posthospital care coordinated by an APN had reduced rehospitalizations in high risk older patients.
Which advantages are provided to the chronically ill patient by personal electronic monitoring devices? select all that apply
a. Helps provide more patient control of their health
b. eliminates need for regular medical and nursing follow up
c. Helps the early identification of patient health related problems
d. Helps health care providers in keeping track of the patient’s health status
e. cost is often covered by Medicare
A,C,D,E
A patient expresses concern that she is at risk for breast cancer. To best assess the risk for this patient, what is the best initial action?
a. Ask if there is a family history of breast cancer
b. Gather and record a three generation pedigree
c. Order a genetic test for the breast cancer gene
d. Recommend direct to consumer genetic testing.
b. Gather and record a three generation pedigree
This is the first step of assessing for genetic risk factors
must do at least 3 generation on maternal and paternal sides
A patient asks about direct to consumer genetic testing, What will the provider tell the patient?
a. It is not useful for identifying genetic diseases
b. Much of the information does not predict disease risk
c. The results are shared with the patient’s insurance company
d. The results must be interpreted by the provider
b. Much of the information does not predict disease risk
There are multiple companies that offer genetic testing without a provider ex 23 and me
Pros; increase awareness of genetic diseases,
CONS: do not offer genetic counseling
-They may show markers for a disease but they
are strongest to indicate disease
- they cannot be used to predict the likely hood
of specific diseases occurring.
Which behavior is most characteristic of early adolescence?
a. arguing with parents and teachers
b. assimilating adult roles and thinking
c. exhibiting fatigue more frequently
d. experimenting with sex and risky behaviors
a. arguing with parents and teachers
Early ( 10-14)
mood swings, argumentative, tremendous physical growth, body changes
Middle (15-17)
fatigue and are experimenting with risky behaviors
strongly influenced by peers
Late ( 18-21)
abstract thinking, assimilate adult roles
What is the initial sign of puberty in the adolescent male?
a. Deepening of the voice
b. elongation of the penis
c. nocturnal emissions
d. testicular enlargement
d. testicular enlargement
A parent reports that an adolescent child does well in school, but seems to consistently make poor decisions about activities with friends. What will the practitioner recommend as an approach to help the adolescent make better decisions?
a. Correcting the adolescent’s decisions and judgments
b. Listening without making suggestions about choices
c. Making decisions for the adolescent to provide guidance
d. providing information about appropriate behavior
b. Listening without making suggestions about choices
What is the focus of the Minority Stress Theory?
a. clarifying the various terms used to describe the LGBTQ community
b. understanding the health needs of select members of the sexual minority community
c. helping health care providers eliminate biases in the care they provide to the members of the LGBTQ community
d. facilitating the management of stress related to the lifestyle choices made by members of sexual minority populations
b. understanding the health needs of select members of the sexual minority community
The focus of the Minority stress theory is to provide a framework to the understanding of the health disparities in the sexual and gender minority communities.
What is the medical diagnostic term used to identify transgender patients? a. gender dysphoria b. gender expression disorder c. gender identity disorder d, gender role unconformity
a. gender dysphoria
A woman who is currently pregnant reports that she has had three previous pregnancies: twins delivered at 35 weeks gestation (both living), one at 38 weeks gestation (living), and one miscarriage at 16 weeks gestation. How will this be recorded as her G/TPAL in her electronic record?
a. G4P: 1113
b. G4P: 1213
c. G5P: 1113
d. G5P: 1213
a. G4P: 1113
Gravidity (G) = total # of pregnancies that has occurred in her lifetime (includes if currently pregnant)
T = # of term pregnancies (born > 37 weeks)
P = # of preterm (born between 20-36 wks)
A = # of abortive (spontaneous or elective)
L = Living births
A pregnant woman who is overweight has no previous history of hypertension or diabetes. Her initial screening exam reveals a blood pressure of 140/90 and a fasting blood glucose of 128. What will the practitioner do?
a. Initiate Insulin therapy
b. Monitor blood pressure and fasting blood glucose closely
c. prescribe and antihypertensive medication
d. refer the patient to a high risk pregnancy specialist
b. Monitor blood pressure and fasting blood glucose closely
This patient is at risk for HTN and DM during r/t patient being overweight
Her BP and glucose are in the high end of normal in which case should monitor closely. Also watch for protein.
BP 120 to 140/90 no lower than 105
The mother of a 3-day old newborn reports that her infant feeds every 4 hours during the day and sleeps 6 hours at night. What will the provider recommend?
a. awakening the baby every 3 hours to feed
b. continue this schedule until the infant is 6 months
c. ensuring that her infant feed for 15-20 minutes each time
d. pumping her breasts to maintain her milk supply
a. awakening the baby every 3 hours to feed
Newborns should feed 8-12 times a day and mothers should be encouraged to awaken a sleepy baby to feed every 2-3 hours or more.
as the baby grows feeds can be spaced out
An infant who has just begun nursing develops hyperbilirubinemia. What will the provider tell the mother?
a. To decrease the frequency of breastfeeding
b. to supplement feedings with extra water
c. to switch formula until bilirubin level drops
d. to use a breast pump to increase her milk supply
d. to use a breast pump to increase her milk supply
Infants with suboptimal breastfeeding can have starvation jaundice and mothers should be encouraged to increase the frequency of breastfeeding and should be offered a breast pump to increase milk supply.
starvation jaundice happens when feedings are infrequent ( can be related to decrease in mother’s supple) then so are stools and bilirubin gets reabsorbed through meconium
A mother who has been breastfeeding her infant for several weeks develops a fever, breast warmth and breast tenderness. What will the provider recommend?
a. Ice packs and decreased frequency of nursing
b. Ice packs and increased frequency of nursing
c. warm packs and decreased frequency of nursing
d. warm packs and increased frequency of nursing
d. warm packs and increased frequency of nursing
this mother has symptoms of mastitis
A pregnant woman reports not having had any vaccinations during her pregnancy. Which vaccines may be given?
a. HPV
b. Inactivated flu
c. Live, attenuated flu
d. MMR
e. TDAP
f. Varicella
a. HPV
b. Inactivated flu
e. TDAP
No live vaccines like flu, varicella or MMR
Tdap is recommended to all patients between 26-36 weeks
An unaccompanied teenager is being treated in the emergency room for stomach pains. Which statement would alert the health care provider to the possibility that the patient may be a victim of human trafficking?
a. “I can’t pay to see a doctor.”
b. I’ve never been to a hospital before.”
c. “you are being very nice to me.”
d. “please, please don’t hurt me.”
d. “please, please don’t hurt me.”
Red flags of victim of human trafficking:
- profound fearfulness during exam
- avoiding eye contact
- disoriented to time and place
- signs of abuse
- substance use
- tattoos
- inconsistent story
- do not know address of residence
- illiterate
- often appears younger than stated age
A health care provider strongly suspects that the patient being treated for a laceration to he forehead may be a victim of human trafficking. What intervention should be implemented initially before proceeding with a complete screening?
a. determine the patients ability to consent to treatment
b. begin cleansing the wound in preparation for suturing
c. transfer the patient to a private treatment room
d. notify the police of the situation
c. transfer the patient to a private treatment room
must provide privacy and a secure location for questioning away from any one
What assessment data would trigger the health care provider’s suspicion that the patient seen in the ER may be a victim of human trafficking? Select all that apply
a. Provides details related to cause of injury
b. appears to be illiterate
c. has a “$50” tattooed on the left shoulder
d. cannot provide a local address of residence
e. looks much younger that stated age of 21
B,C,D,E
What intervention will the provider implement when prescribing medications to an 80-year old patient?
a. beginning with higher doses and decrease according to the patient’s response
b. Consulting the Beers list to help identify potentially problematic drugs
c. ensuring that the patient does not take more that five concurrent medications
d. reviewing all patient medications at the annual health maintenance visit.
b. Consulting the Beers list to help identify potentially problematic drugs
The Beers list provides a list of potentially inappropriate medications in all patients aged 65 and older and helps minimize drug-related problems in the age group. older patients should started on lower doses wit gradual increase depending on responses. Patient who take 5 or more drugs are at risk for increased problem however most patients take more. they just must be monitored more closely
An 80-year old women who lives alone is noted to have a recent weight loss of 5 pounds. She appears somewhat confused., according to her daughter, who is concerned that she is developing dementia. The provider learns that the woman still drives, volunteers at the local hospital and attends a book club with several friends once a month. What is the initial step in evaluating this patient?
a. obtaining a CBC, serum electrolytes,, Bun, and glucose
b. ordering a CB serum ferritin and TIBC
c. Referring the patient to a dietician for nutritional evaluation
d. referring the patient to a neurologist for evaluation for AD
a. obtaining a CBC, serum electrolytes,, Bun, and glucose
mental cognition changes in older adults may have other possible differential diagnosis. Detailed history from patients family and friends are vital in determining the diagnosis of dementia.
could be dehydration, poly pharmacy related, nutritonal problems UTIs etc
The practitioner is establishing a plan for routine health maintenance for a new client who is 80 years old the client has never smoked and has been in good health. What will the practitioner include in routine care for this patient? select all that apply
a. annual htn screening
b. baseline abd aorta uS
c. colonoscopy every 10 years
d. one-time hepatitis B vaccine
e. Pneumovax vaccine if not previously given
f. Yearly influenza
e. Pneumovax vaccine if not previously given
f. Yearly influenza
One time pneumovax is given after age 65. Influenza should be offered every year. HTN should be screened at EVERY visit. abd aorta is only performed once on a every smoking male. Colonoscopy is performed every 10 years after the age of 50 but not after the age of 74
health screening for older adults is controversial and not routinely done other than a few things.
When should palliative care be initiated by a primary care provider?
a. after an ill patient asks for hospice services
b. as part of routine health maintenance
c. when a patient is diagnosed with a serious disease
d. when an interdisciplinary team is formed to manage a disease
b. as part of routine health maintenance
Palliative care support begins with an understanding of a patient’s preferences and helping tis patient to identify goals of care. **must of good communication” health care providers must initiate conversation as part of initial health history regardless of health status. Does not have to wait to be started when diagnosed with serious disease or when patient asks for hospice.
When should palliative care be initiated by a primary care provider?
a. after an ill patient asks for hospice services
b. as part of routine health maintenance
c. when a patient is diagnosed with a serious disease
d. when an interdisciplinary team is formed to manage a disease
b. as part of routine health maintenance
Palliatieve care support begins with an understanding of a patinet’s preferences and helping tis patient to identify goals of care. **must of good communication
