ACHPN Exam 181 Questions with Verified Answers,100% CORRECT

ACHPN Exam 181 Questions with Verified Answers Hiv/aids hospice criteria - CORRECT ANSWER CD4 count < 25 Viral load > 100,000 Weight loss more than 10% in 3 months Pps 50or less Treatment of OIH - CORRECT ANS ...

ACHPN Exam 181 Questions with Verified Answers Hiv/aids hospice criteria - CORRECT ANSWER CD4 count < 25 Viral load > 100,000 Weight loss more than 10% in 3 months Pps 50or less Treatment of OIH - CORRECT ANSWER Stop opioids and start ketamine Hospice criteria COPD - CORRECT ANSWER Fev1 after bronchodilator less than 30% O2 sat less than 88% on RA Dyspnea at rest No response to bronchodilator What bronchodilator to treat mild to severe copd - CORRECT ANSWER SABA albuterol or levalbuterol What is FEV1 - CORRECT ANSWER forced expiratory volume in one second Beck Depression Inventory (BDI) - CORRECT ANSWER a questionnaire useful for determining the level of depressive symptoms that a person is reporting Cancer Diagnosis most related to patient depression - CORRECT ANSWER Pancreatic To treat hiccups patient with ESRD - CORRECT ANSWER Baclofen 5-10 mg po tid Which of the following diagnosis is has a typical trajectory of overall decline with repeated acute episode of illness and functional decline - CORRECT ANSWER Congestive heart failure CervicalCancer patient 24 yrs old , md thinks depressed but she is hopeful, in a support group and educating her self about dx. What is this? - CORRECT ANSWER Adjustment What drug has been useful in the treatment of depression in medically ill patients? - CORRECT ANSWER Methylphenidate Methylphenidate (Ritalin) - CORRECT ANSWER Treatment of nausea and to increase appetite. Initial dosage is 2.5 mg before lunch and dinner or just a evening dose at 2.5mg up to 20 mg daily Maslow's Hierarchy of Needs - CORRECT ANSWER physiological basic life system needs safety and security tlove and belonging self-esteem Painad - CORRECT ANSWER assessment tool for pain; assesses 5 common behaviors: breathing, vocalization, facial expression, body language, and consolability. A score of 4 or above indicates a need for pain management. What is the most challenging to assess in a patient with progressive cva with dysarthria and impaired executive fuction? - CORRECT ANSWER Pain Name three drugs to treat dementia - CORRECT ANSWER Mild to moderate Donepezil (aricept) Galaantamin ( razadyne) Severe/ moderate nameda What test and score can support a diagnosis of dementia - CORRECT ANSWER MMSE ( mini mental state exam) Score below 25 Score below 15 can not adequately state pain Stage C of heart failure ACCF/AHA Meds for Managment - CORRECT ANSWER Increased shortness of breath Edema Chest pain with most activity Loop diuretic and ACEI Describe opiate withdrawal symptoms - CORRECT ANSWER Goose flesh, irritability, insomnia, diarrhea, tremors Tylenol withdrawal symptoms - CORRECT ANSWER Nausea, abdominal pain, anorexia Evaluate drug dosing Which medication catagory most often precipitates depressive symptoms - CORRECT ANSWER Steriods Copd first line medical management - CORRECT ANSWER Bronchodialators O2 Ant inflammatory drugs AHA/ACC Stage B - CORRECT ANSWER Structural heart disease who have never had signs or symptoms of HR Comparable to NYHA 1 mild Ask-Tell-Ask method - CORRECT ANSWER What do you already know and what do you want to know Treatment for diarrhea - CORRECT ANSWER Lopermide inital dose 4 mg then 2.5 mg after every stool up to 16 mg per day PPS of 50 or below - CORRECT ANSWER Extensive disease and condition is deteriorating SPIRIT - CORRECT ANSWER Spirit- religious affiliation Personal- practice beliefs Integration- participation in spiritual community Ritual-practices religious that effect healthcare Implication- aspects of spirituality you want providers to keep in mind Terminal event-religious feelings about death Stage D (ACC/AHA) - CORRECT ANSWER Advanced structural heart disease with refactory symptoms of HF, requiring interventions Comparable to IV NYHA ACC/AHA Stage C - CORRECT ANSWER past or current symptoms of HF assoc w/ underlying heart dz (structural) Comparable to mild II moderate III Stage A (ACC/AHA) - CORRECT ANSWER High risk patients of developing HF due to metabolic syndrome, obesity HTN and CAD What is the Lanss pain scale? - CORRECT ANSWER Used to assess neuropathic pain Flannigan - CORRECT ANSWER Adults chronically ill 16 elements to assess qaulity of life Spiritaul eval tools - CORRECT ANSWER Hope , Fica and spirit Native american - CORRECT ANSWER No out ward expression of pain What is mantle radiation? - CORRECT ANSWER Radiation to the chest Nursing Process - CORRECT ANSWER Assess, plan, intervene (implement) and evaluate Lung cancer local tumor symptoms - CORRECT ANSWER Persistent cough, dyspnea hymoptosis pneumonitis What is Horner's syndrome? - CORRECT ANSWER ptosis, miosis, anhydrosis 6 minute walk test - CORRECT ANSWER What is xerostomia? - CORRECT ANSWER dryness of the mouth orthopnea - CORRECT ANSWER difficulty breathing when lying down Methadone has what half life - CORRECT ANSWER Long/ requires week or longer to reach a steady state What must a patient have before initiation of methadone - CORRECT ANSWER Ekg ECoG - CORRECT ANSWER Pain scale 0-5 0 fully active 1 restricted in activity/ ambulatory/ work 2 self care no work ambulatory 3limited self care bed/chair confined more than 50% 4. Totally confined to chair bed help all Adls 5.death -asthenia - CORRECT ANSWER weakness Superior vena cava syndrome - CORRECT ANSWER Tumor can compress SVC and cause swelling of face, JVD, and visible chest veins tumor lysis syndrome - CORRECT ANSWER Chemotherapy.... 3 days after increase k+, phosphorus, uremia and hypocalcemia life threatening condition when by products are released into blood stream after large number of cancer cells are destroyed High flannagin or qols means - CORRECT ANSWER Dissatisfaction with qols Dementia stages of progression - CORRECT ANSWER No functional impairment to severe fast of 7 - CORRECT ANSWER Less than 6 words daily Cannot dress or bathe Increase incontinence Inability to walk without assistance Inability sit or hold head up Complications of dementia - CORRECT ANSWER Aspiration Pneumonia Pyleonephritis Sepsis Bed sore advanced ALS prognosis - CORRECT ANSWER 3-6 yrs from diagnosis What is normal in ALS - CORRECT ANSWER ESR Only med for ALS to slow progression but expensive - CORRECT ANSWER Riluzole Locked-in syndrome - CORRECT ANSWER Condition in which a patient is aware and awake but cannot move or communicate verbally because of complete paralysis of nearly all voluntary muscles seen in ALS Chorea - CORRECT ANSWER movements that are sudden, random, and involuntary Chorea management - CORRECT ANSWER Haldol Progression of Huntington's Disease - CORRECT ANSWER Dysphagia, excessive chorea activity metabolic disturbances Esrd hospice criterea - CORRECT ANSWER No dialysis Creatinine clerance less than 10 Serum creatinine greater 8 Uremia Oliguria less tan 400 in 24 hrs Hyperkalemia Asterixis - CORRECT ANSWER tremor of the hand when the wrist is extended Criteria for end stage hepatic disease - CORRECT ANSWER Not a liver transplant canidate Ptt greater than 5seconds Albumin less than 2.5 Ascities despite max diuretic Bact peritonitis Hepatorenal syndrome Encephalopathy Spinal cord compression is mostly seen in what patients? - CORRECT ANSWER Lung breast and prostate CA Cancer patient increased back pain while lying flat - CORRECT ANSWER Spinal cord compression Managment of spinal cord compression - CORRECT ANSWER Assess goals high dose steriods neurosurgery and radiation oncology Beneficence - CORRECT ANSWER To do in a way that ism in the best intreast of the patient Non-maleficence - CORRECT ANSWER do no harm veracity - CORRECT ANSWER truthfulness Borborygmi - CORRECT ANSWER stomach growling Med relief for patients woth pruritis with cirrohsis - CORRECT ANSWER Rifampin What medication can treat cholera in huntingtons disease - CORRECT ANSWER Tetrabenazine Antidepressants and mood stabilizer Frontotemporal Dementia - CORRECT ANSWER 50s disinhibited or rigid ritualistic behaviors Increase intreast in sex Crave sweet fatty foods Greatest cause of death in parkinsons patients - CORRECT ANSWER Aspiration pneumonia What is uncomplicated grief? - CORRECT ANSWER A persistent yearning for a deceased person that often occurs without signs of depression Stroke eligability fir hospice - CORRECT ANSWER Kps 40 or less What is fedelity? - CORRECT ANSWER The duty to do what has been promised exaggerated grief - CORRECT ANSWER Grief leads to self destructive behavior masked grief - CORRECT ANSWER Behaviors interfere with normal functioning but are not reconized by the person disenfranchised grief - CORRECT ANSWER Socially not recognized grief, ex spouse, terminated pregnancy complicated grief - CORRECT ANSWER a type of grief that impedes a person's future life, usually because the person clings to sadness lasts over one year is considered Ethnocentrism - CORRECT ANSWER Refers to the tendency of people to veiw there way of thinking acting and behavior as the only right way Which organization develops disseminates,and updates the clinical practice guidelines for quality palliative care - CORRECT ANSWER National coalition for hospice and palliative care Ana statement on hospice palliative - CORRECT ANSWER Promote and improve the patients quality of life through relief of suffering along the course of illness Refers to the tendency of people to view there way of thinking acting and behavior as the only right way - CORRECT ANSWER Ethnocentrism Treatment for hypercalcemia - CORRECT ANSWER Reduction of tumor Loop diuretic Biophsponates Hypercalcemia level - CORRECT ANSWER greater than 10.5 humeral hypercalcemia of malignancy - CORRECT ANSWER 80% Parathyroid level - CORRECT ANSWER 10-60 What drugs can cause parathyroidism - CORRECT ANSWER Lithium thiazides What cancer causes siadh - CORRECT ANSWER Usually small cell lung cancer What does siadh cause - CORRECT ANSWER Hyponatremia double effect - CORRECT ANSWER When the act has 2 foreseen effects, one good and one harmful Medicare Part A(Inpatient) - CORRECT ANSWER Covers people over 65, covers any institutions and treatments in many centers from hospitals to hospice Medicare Part B - CORRECT ANSWER Persons 65 and older or people with certain disabilities, covers providers, DME , home health, outpatient care How does Asian. Latin and hispanic cultures often verbalize there psychological stress? - CORRECT ANSWER Somatic language such as headache, GI disterbance, fatigue or weakness. Generalized Anxiety Disorder (GAD) - CORRECT ANSWER a disorder characterized by chronic excessive worry for more days than not 60 for 6 months or more panic disorder - CORRECT ANSWER an anxiety disorder that consists of sudden, overwhelming physical discomfort and fear accompanied by intense physical symptoms. Theess medications used in palliative Medicine that can cause Anxiety - CORRECT ANSWER Phenothiazines, butyrophenones and metoclopramide What is phenothiaines - CORRECT ANSWER Treat severe mental illnesses example drugs thorazine, mellaril, prolixin What can you do to not trigger PTSD - CORRECT ANSWER Avoid bed alarms and restraints. Remain in the patients line of site Meds to treat ptsd - CORRECT ANSWER SSRI or Tricyclic antidepressants First line tratment for anxiety - CORRECT ANSWER Benzodiazepines such as ativan xanex librium What do high gleason scores represent? - CORRECT ANSWER More aggressive prostate cancer What may relieve pain in patients with spinal cord compression - CORRECT ANSWER sitting or standing what is the diagnostic test of choice for Scc - CORRECT ANSWER MRI what causes superior vena cava syndrome - CORRECT ANSWER any condition that leads to obstruction of blood flow through the svc Svc obstruction is most likely involve which pathological processes? - CORRECT ANSWER right lung, lymph nodes, mediastinal structures Management of Spinal Cord compression who are still ambulatory - CORRECT ANSWER high doses dexamethasone and radiation therapy what symptoms are associated with SVCS are considered emergent? - CORRECT ANSWER Stridor, dyspnea, decreased cardiac output, impaired cognition what is the treatment for emergent SVCS - CORRECT ANSWER high dose corticosteroids What is safe passage - CORRECT ANSWER A part of caring practice that ensures patient safety in a broad sense Meds snd treatments no errors Correct info about treatments Prevent infection Medicare D - CORRECT ANSWER Covers prescription drugs Medicare A - CORRECT ANSWER Acute hospital, home health and hospice care Medicare B - CORRECT ANSWER Covers MDs APRNs nurse lab physical and occupational therapy Hospice care for the terminally ill is for how long - CORRECT ANSWER Two 90 day period May be extended by md auth every 60 days Stroke patients must have a pps of? - CORRECT ANSWER 40%or below Cancer patients must have a pps of what or below? - CORRECT ANSWER 70% Define myoclonus - CORRECT ANSWER Twitching of the hand periodically and can be a side effect of opioids What is a common complication of pancreatic cancer - CORRECT ANSWER Duodenal obstruction Als patients lose the ability to control emotions causing inappropriate laughter or crying this is callec - CORRECT ANSWER Pseudobulbular affect Myoclonus treatment - CORRECT ANSWER Labs for hydration renal function first then possible treatment Mortality rate with a patient with lvad 3 years - CORRECT ANSWER 65% Mortality rate of patient with lvad within 4 years implantation - CORRECT ANSWER 82% Lvad - CORRECT ANSWER Not a pacemaker but a mechanical device that assumes the function of heart What is mindfullbased stress reduction - CORRECT ANSWER Meditation that helps patients cope with illness pain and stress Dignity therapy - CORRECT ANSWER Helps patients find meaning by writing their legacy Meaning centered psycotherapy - CORRECT ANSWER Addresses spririt Psycodynamic psychotherapy - CORRECT ANSWER Relieves depression stress anxiety while uncovering the unconscious mind. Pseudo addiction - CORRECT ANSWER Reflects behaviors of opioid abuse such requesting refills but actually is a result of poorly controlled pain. Allodynia - CORRECT ANSWER Most common side effect of cancer treatment - CORRECT ANSWER When cancer invades the bones and erodes bine tissue calcium is released into the blood causing? - CORRECT ANSWER Hypercalcemia Firstline treatment for nausa and vomiting - CORRECT ANSWER Anticholinergics Patient with active seizure at home family shouldhave what med on hand - CORRECT ANSWER Rectal diazepam 10mg rectal gel Oih involves which receptors - CORRECT ANSWER NMDA receptors Calcium has a direct relationship with ? - CORRECT ANSWER Phosphorus Blood calcium rise Phosphorus level falls What condition indicates a worsening of CHF - CORRECT ANSWER Hyponatremia do to release of anti diuretic hormone Difference between vegetative state and coma - CORRECT ANSWER Vegetative state has sleep wake cycles Vegatative state after how many months have low recovery? - CORRECT ANSWER 6 months Relief of puritis in End stage liver - CORRECT ANSWER Bile resin binder such as cholestyramine (questran) End stage liver hospice criteria - CORRECT ANSWER PT greater than 5 INR greater than 1.5 Albumin less than 2.5 What medication is cabergoline used for? - CORRECT ANSWER Early parkinsons Pps score less than 30 means - CORRECT ANSWER Bedridden What puts a patient more at risk for drug abuse - CORRECT ANSWER Personal /family history of abuse Three highest cancers with poor prognosis if they forego treatment that will meet hospice criterea - CORRECT ANSWER Small cell lung 2-3 months Pancreatic 4-8 months Brain tumor 6-8 months Aids Pps score criterea - CORRECT ANSWER Pps of 50 Una boot contraindication - CORRECT ANSWER Bedbound Get up snd go test what score gives an increased fall risk - CORRECT ANSWER 14 seconds or greater What is important for patients to know when discussing plan of care - CORRECT ANSWER Rights and responsibilities Stroke PPS - CORRECT ANSWER Less than 40 What dressing should be placed in a patient with osteomyelitis with drainage having to change bandage 4-5 times daily - CORRECT ANSWER Hollister wound management pouch American geriatric society states after one fall during the year a patient should be assed for - CORRECT ANSWER Gait and balance if issues are found full assessment should be done via get up and go Braden score for patient for skin breakdown - CORRECT ANSWER Equal to or less than 16 What is a normal breath count in a patient with MG - CORRECT ANSWER 50 or greater How long does it take for palliative chemo to work - CORRECT ANSWER 3-12 months Assess equals - CORRECT ANSWER Emr review patient assessment Plan equals - CORRECT ANSWER Plan of care / review orders implement - CORRECT ANSWER Provide treatment and care diagnostic tests evaluate - CORRECT ANSWER Evaluate outcomes/ interpret results / assess compliance Goals before - CORRECT ANSWER Treatment What does pain activate - CORRECT ANSWER Nororeceptors by noxious stimulus What is somatic pain? - CORRECT ANSWER Pain caused by damage to the bone skin or neves Example bone metastasis, osteoarthritis Central somatozation - CORRECT ANSWER Sensitivity of central pain NMDA receptors Allodynia - CORRECT ANSWER Pain due to a stimulus that does not normally provoke pain (non noxious stimulus) Hyperalgesia - CORRECT ANSWER excessive sensitivity to painful stimuli parasthesia - CORRECT ANSWER abnormal sensation such as numbness and tingling Dysthsia - CORRECT ANSWER Any painful paresthesia Incident pain occurs when - CORRECT ANSWER Pain with movement Uncontrolled baseline pain - CORRECT ANSWER Pain uncontrolled by existing opiod regular schedule Anhedonis - CORRECT ANSWER Loss of enjoyment/interest in activity Suicide assessment - CORRECT ANSWER Do not leave alone , explore further and consult mental health Calciphylaxis - CORRECT ANSWER Painful syndrome of small blood vessels located in fatty tissues, blood clots and death of skin Management of hemmorage - CORRECT ANSWER Deep sedation dygeusia - CORRECT ANSWER altered taste Ppi scale is to determine - CORRECT ANSWER Disease progression Functional scales used are - CORRECT ANSWER Kps pps and ecog Duodenal obstruction assessment - CORRECT ANSWER Splashing bowel sounds emesis undigested food Preperstion for fentanyl patch - CORRECT ANSWER Clip hair no shave wash with water only What is the max you can drain with pleurx cath - CORRECT ANSWER 2000 What is the max you can drain with hospital paracentesis - CORRECT ANSWER 5000 ml Coolness in extremities distal to proximal death prediction? - CORRECT ANSWER 2-3 hours Another term for protien calorie malnutrition - CORRECT ANSWER Maramus