ACHPN Exam 135 Questions with Verified Answers,100% CORRECT

ACHPN Exam 135 Questions with Verified Answers Class I HF - CORRECT ANSWER asymptomatic during normal activities, no pulmonary congestion or hypotension, no activity restriction-good prognosis Class II HF - CORRE ...

ACHPN Exam 135 Questions with Verified Answers Class I HF - CORRECT ANSWER asymptomatic during normal activities, no pulmonary congestion or hypotension, no activity restriction-good prognosis Class II HF - CORRECT ANSWER Some symptoms on physical exertion, absent at rest, some limited ADLS. Slight pulmonary edema, may have basilar rales. Good prognosis Class III HF - CORRECT ANSWER Obvious ADL limited, discomfort on any exertion, fair prognosis. Class IV HF - CORRECT ANSWER Symptoms at rest, poor prognosis DIAPERS mnemonic for incontinence - CORRECT ANSWER Delirium Infection Atrophic urethritis Pharmacy Excessive urine production Stool impaction Biliary cirrhosis itching - CORRECT ANSWER Rifampin 1st choice Ascites max pleurX amount drained - CORRECT ANSWER 2L Greatest risk with lymphedema - CORRECT ANSWER infection Medicare Part A - CORRECT ANSWER hospital, Rehab, HH, hospice-no premium Medicare Part B - CORRECT ANSWER Provider visits, PT, OT-deductible Medicare part D - CORRECT ANSWER Prescription drug coverage Highest risk for Melanoma - CORRECT ANSWER Tanning opioid induced constipation - CORRECT ANSWER docusate (softener) + senna (stimulant)- Best tx for metastatic lung CA with persistent hemoptysis - CORRECT ANSWER palliative radiation tumor lysis syndrome - CORRECT ANSWER hyperphosphatemia, hyPocalcemia, hyperkalemia (EKG changes), and hyperuricemia. Prevention of tumor lysis syndrome involves hydration and the use of hypouricemic agents such as allopurinol or rasburicase lateral violence - CORRECT ANSWER verbal, emotional, or physically abusive behavior of a registered nurse toward another staff member horizontal violence - CORRECT ANSWER anger and aggressive behavior between nurses or nurse-to-nurse hostility National Cancer Institute Scale of Severity of Diarrhea - CORRECT ANSWER Score 1=2-3 stools a day 2=4-6 stools and night time stools, cramps 3=7-9 stools, severe cramps, incontinence 4=10+ grossly bloody, needs IVFS double effect - CORRECT ANSWER A situation in which an action (such as administering opiates) has both a positive effect (relieving a terminally ill person's pain) and a negative effect (hastening death by suppressing respiration). Severe ischemia PAD ABI - CORRECT ANSWER 0.5-0.75 ABI <0.5 - CORRECT ANSWER pain, at rest, limb threatened ABI <0.25 - CORRECT ANSWER Critical limb threatening condition Normal ABI range - CORRECT ANSWER 1-1.1 DASH diet - CORRECT ANSWER increase fruit, vegetables, and low fat dairy, <6 oz meat 3 basic types of failures in organization - CORRECT ANSWER skill based, rule based, knowledge based communication assistance in Broca's aphasia - CORRECT ANSWER Picture charts, FACES scale problem focused requirements - CORRECT ANSWER CC, HPI, 1-3 elements expanded problem focused - CORRECT ANSWER CC< HPI, problem pertinent ROS, detailed exam guidelines - CORRECT ANSWER CC, extended HPI, ROS, PMH, FMH, and social hx Comprehensive requirements - CORRECT ANSWER CC< extend HPI, complete ROS, and PFSH Needs Assessment Process - CORRECT ANSWER Determine information needed select data method develop tools, questionnaires, procedures train data collectors select a sample conduct needs assessment analyze data and identify needs left hemisphere CVA symptoms - CORRECT ANSWER residual weakness expressive aphasia difficulty with math short-term memory loss slow cautious behavior needs repeated instructions Marasmus (protein-calorie malnutrition) - CORRECT ANSWER Inadequate intake of protein and calories gradual weight loss intact visceral protein loss of skeletal muscle mass Kwashiorkor Malnutrition *deficiency* *findings* - CORRECT ANSWER protein malnutrition rapid loss of visceral protein skeletal muscle mass retained more difficult to detect Protein for wound healing - CORRECT ANSWER 1.25 to 2 g/kg daily Glascow Coma Scale - CORRECT ANSWER Coma 3-8 Severe <8 Moderate 9-12 Minor >13 respiratory acidosis - CORRECT ANSWER low pH, high CO2 respiratory alkalosis - CORRECT ANSWER high pH, low CO2 metabolic acidosis - CORRECT ANSWER Low pH, Low HCO3; Compensation: Respiratory Alkalosis metabolic alkalosis - CORRECT ANSWER High pH, High HCO3; Compensation: Respiratory Acidosis Wernicke's encephalopathy triad - CORRECT ANSWER confusion, ataxia, ophthalmoplegia Wernicke-Korsakoff syndrome - CORRECT ANSWER Organic brain syndrome resulting from prolonged heavy alcohol use, involving confusion, unintelligible speech, and loss of motor coordination. It may be caused by a deficiency of thiamine, a vitamin metabolized poorly by heavy drinkers. Benner's stages of nursing proficiency - CORRECT ANSWER novice, advanced beginner, competent, proficient, expert compression stockings classifications - CORRECT ANSWER Class I 20-30mm/hg-provide support varicose veins Class II 30-40 mm/hg-prevent venous ulcers Class III 40-50 mm/hg-treatment of refectory ulcers and control lymphedema Class IV 50-60 mm/hg, treatment of severe lymphedema suppression coping mechanism - CORRECT ANSWER trying to forget, conciously choosing not to deal with issues repression coping mechanism - CORRECT ANSWER forgetting, unconciously failing to recall traumatic incident/feelings Sublimation (coping mechanism) - CORRECT ANSWER Redirecting any social-unacceptable drives into more appropriate activities. (Turning ones anger into art) Denial coping mechanism - CORRECT ANSWER Seeking other opinions, changing doctors terminal anguish - CORRECT ANSWER inability to repress or suppress painful unresolved psychological issues, severe suffering continuous home care - CORRECT ANSWER Reimbursement for continuous home care under the hospice Medicare benefit is based on specific criteria as defined in the benefit. This level of care is designated for brief periods of crisis as a supportive means to help the terminally ill patient stay at home. Care must be provided for at least 8 hours per day, and more than 50% of care must be provided by skilled nursing staff (RN or LPN/LVN). Required for level of care change - CORRECT ANSWER Primary physician order mainstay treatment for pruritis - CORRECT ANSWER moisturizer enzymatic wound dressing - CORRECT ANSWER wounds with necrotic tissue and eschar most urgent symptom of brain mets - CORRECT ANSWER seizures factors associated with diarrhea in bone marrow transplant - CORRECT ANSWER radiation and graft vs. host disease Non-REM sleep - CORRECT ANSWER restful sleep, quiet phase, voluntary muscles are not paralyzed REM sleep - CORRECT ANSWER the stage of sleep marked by rapid eye movements, dreaming, and paralysis of motor systems ICP-related nausea and vomiting treatment - CORRECT ANSWER scopalamine Prochlorperazine - CORRECT ANSWER opioid-induced nausea and some chemotherapy-associated nausea; octreotide acetate - CORRECT ANSWER nausea and vomiting specific to intestinal obstruction. Reglan - CORRECT ANSWER treatment for nausea/vomiting associated with an ileus Uremic pruritus treatment in ESRD - CORRECT ANSWER Sertaline, mirtazapine and paroxetine have shown efficacy in management of pruritus in this population non-pharmacologic approach to stimulating saliva for a dry mouth - CORRECT ANSWER peppermint water tricyclic antidepressant that is not the preferred choice for use for treating neuropathic pain - CORRECT ANSWER amitriptyline best explanation of the use of music therapy to decrease pain - CORRECT ANSWER Music provides a soothing, safe environment that helps to decrease pain. CMS regulations require a face-to-face visit for which of the following patient types - CORRECT ANSWER .A Medicaid patient being recertified prior to the start of the 3rd benefit period six key principles of Quality Improvement (QI) - CORRECT ANSWER Customer-driven, System optimization and alignment, Continual improvement and innovation, Continual learning, Management through knowledge, and Collaboration and mutual respect. stages of adaptation to hospice/palliative care nursing - CORRECT ANSWER Intellectualization, Emotional survival, Depression, Emotional arrival, and Deep compassion. long-term side effect is unique to doxorubicin - CORRECT ANSWER cardiotoxicity Plant Alkaloids, etoposide, taxanes and platinum compounds long-term side effect - CORRECT ANSWER neurotoxicity cisplatin, high dose methotrexate or streptozocin common side effect - CORRECT ANSWER nephrotoxicity cyclophosphamide; pulmonary fibrosis - bleomycin-common side effect - CORRECT ANSWER hemorrhagic cystitis 70-90% of patients with advanced disease - CORRECT ANSWER experience pain It is estimated that 85-90% of patients with pain could be - CORRECT ANSWER pain free Rofecoxib is what name brand drug - CORRECT ANSWER Vioxx-pulled from market Celecoxib (brand - Celebrex® can be used as an adjunct for what? - CORRECT ANSWER Bone pain appropriate starting dose for nortriptyline or desipramine - CORRECT ANSWER 10-25 mg po at hs titrate slow sedating Inadequate pain control may hasten a patient's death by - CORRECT ANSWER Increasing the workload of the heart and lungs Causing increased physiological stress Increasing the risk of pneumonia best intervention wit true respiratory depression in the palliative setting, - CORRECT ANSWER a slow IV infusion of diluted naloxone is better than a naloxone bolus Intractable hiccups can result in which of the following conditions - CORRECT ANSWER Insomnia, depression, anorexia, anxiety. wound that would be at great risk for rapid evolution into a serious, higher staged, non-healing wound - CORRECT ANSWER hip wound The most effective method of resolving conflict is which of the following - CORRECT ANSWER confrontation common for cancer patients to have secondary pain related to - CORRECT ANSWER debility postherpetic neuropathy adjuvant treatment for incomplete pain management. - CORRECT ANSWER 5% Lidocaine patches are used for topical relief pamidronate uses - CORRECT ANSWER IV infusion for hypercalcemia associated with malignancy and metastatic bone disease and for treating Paget's disease (caused by excess breakdown of bone) Cachexia - CORRECT ANSWER weight loss or wasting due to inadequate intake of nutrients anorexia - CORRECT ANSWER lack or loss of appetite or inability to take in nutrients Cirrhosis ascites cause - CORRECT ANSWER decreased osmotic oncotic pressure from decreased albumin The domains of the current research agenda of HPNA include - CORRECT ANSWER structure and processes of care physical aspects of care translation of research into practice classes of medications can be used as an adjuvant to treat neuropathic pain - CORRECT ANSWER anticonvulsants and serotonin-norepinephrine reuptake inhibitors most common site for melanoma mets - CORRECT ANSWER brain most common causes of lymphedema - CORRECT ANSWER tumor pressure constipation surgical procedures most common cause of pericardial effusions leading to increased risk of cardiac tamponade - CORRECT ANSWER metastatic disease diagnostic triad for cardiac tamponade consisting of hypotension, quiet heart sounds and increased jugular venous pressure is actually present in approximately what percentage of patients - CORRECT ANSWER 30 % Pulsus paradoxus is considered the cardinal sign of cardiac tamponade occurred in what percentage - CORRECT ANSWER 77% demonstrated with a systolic drop of greater than 10mm Hg on inspiration Ascites in the presence of which of the following diagnoses does not correlate with a poor prognosis - CORRECT ANSWER ovarian cancer What is the approximate percentage of patients with advanced cancer who will experience nausea and/or vomiting during their illness - CORRECT ANSWER 50% Signs and symptoms of a duodenal bowel obstruction include which of the following - CORRECT ANSWER Severe vomiting of undigested food NO pain NO distension Which of the following symptoms would be most closely associated with a lower GI bleed - CORRECT ANSWER Black, tarry stools Coffee ground emesis - CORRECT ANSWER upper GI bleed The National Hospice and Palliative Care Organization (NHPCO) formulated an updated staffing guideline in 2011 that reflects which of the following factors/characteristics - CORRECT ANSWER Hospice length of stay Staffing model organizational characteristics The most important condition influencing the development of conflict in nursing - CORRECT ANSWER Incompatible goals The type of conflict characterized by mistrust, hostility and fear is which of the following - CORRECT ANSWER Felt Conflict Current legislative issues being addressed at the state level in many states - CORRECT ANSWER DNR Physician-assisted suicide advance care planning pain and symptom management reimbursement most accurate statement regarding the withholding or withdrawing of life-sustaining care? - CORRECT ANSWER Withholding or withdrawing life-sustaining care is analogous to allowing the patient to die a natural death. there is state to state variation in law regarding care that may be withdrawn or withheld asthenia - CORRECT ANSWER weakness Apraxia - CORRECT ANSWER impaired ability to carry out motor activities despite intact motor function sign of dementia HPNA Code of Ethical Conduct are: - CORRECT ANSWER Respect for persons Justice Beneficence Confidentiality Role fidelity Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS) initiated which of the following surveys in 2015 to assess hospice quality? - CORRECT ANSWER CAHPS Hospice Survey was designed to measure and assess the experiences of patients who died while receiving hospice care and their primary informal caregivers National Consensus Project for Quality Palliative Care - Clinical Practice Guidelines for Quality Palliative Care (3rd edition) identifies 8 domains of care. Which domain reflects the Physical Aspects of Care including emphasis on the assessment and treatment of physical symptoms with appropriate, validated tools - CORRECT ANSWER domain 2 Culture is outlined in the NCP for Quality Palliative Care-Clinical Practice Guidelines as - CORRECT ANSWER a source of resilience and strength for the patient and family Quality Assessment and Performance Improvement (QAPI) component of the Hospice Conditions of Participation (CoPs) requires that hospice providers do which of the following - CORRECT ANSWER -Initiate performance improvement projects and demonstrate measurable improvements -Conduct a thorough surveillance of hospice operations including assessment of the impact of medical, psychosocial and spiritual care provided best definition of hospice to other providers/nurses - CORRECT ANSWER Hospice provides expert pain and symptom management through nurses collaborating with the patient's chosen physician, along with supportive social work, spiritual care, hospice aide and volunteer services based upon patient/family needs six key principles as identified by Deming of Quality Improvement (QI) - CORRECT ANSWER Customer-driven System optimization and alignment Continual improvement and innovation Continual learning Management through knowledge Collaboration Mutual respect. oldest and most frequently used method for QI project development is which of the following - CORRECT ANSWER FOCUS- PDSA FOCUS- PDSA - CORRECT ANSWER Find a process to improve; Organize to improve a process, Clarify what is known; Understand variation; Select a process improvement; Plan; Do; Study (check); and Act. The first step in identifying what the objective/goals should be for the process improvement efforts would be to - CORRECT ANSWER identify benchmarks within other hospice organizations Which of the following is identified by JCAHCO as the most frequent root cause of adverse sentinel events - CORRECT ANSWER Communication failures Institute of Medicine's 2001 report on "Crossing the Quality Chasm" 6 key elements - CORRECT ANSWER safety effective patient-centered timely efficient equitable healthcare. five components essential to the pursuit of cultural competence - CORRECT ANSWER cultural awareness cultural knowledge cultural skill cultural encounter cultural desire Compassion fatigue is most accurately reflected by - CORRECT ANSWER secondary traumatic stress experienced by caregivers of those suffering from physical or emotional pain. Burnout is - CORRECT ANSWER the perception that an individual has used up all their available energy and is unable to continue to perform. Negative stress symptoms - CORRECT ANSWER when the degree of stress is greater than the available coping mechanism and apathy, boredom, lack of interest and low motivation occur when the degree of stress is not stimulating enough. six domains within the work environment - CORRECT ANSWER workload control rewards community fairness values. Role redefinition is outlined as - CORRECT ANSWER A personal stress management method to lessen overload and clarify roles. current research agenda for HPNA (2015-2018) includes which of the following domains - CORRECT ANSWER structure processes of care physical aspects of care translation of research into practice HPNA research agenda domain of physical aspects of care, which are the symptoms being addressed - CORRECT ANSWER Dyspnea, constipation and fatigue additional aspects to be investigated related to symptom management include - CORRECT ANSWER assessment tools adequate for population evidence-based interventions for effective symptom management examination of the role of caregivers in symptom management population-specific understanding of symptoms When the nurse helps the public understand the differences between withholding and withdrawing life-sustaining therapies, euthanasia and physician assisted suicide, it is an example of: - CORRECT ANSWER leadership generally, a therapy, including palliative and end of life care, can be withheld or withdrawn under which condition - CORRECT ANSWER he patient's legal surrogate refuses its signs and symptoms are indications that a patient may be experiencing cardiac tamponade - CORRECT ANSWER Muffled heart sounds pericardial friction rub cough dyspnea chest pain jugular venous distention tachycardia pulsus paradoxus only drug approved by the FDA for the treatment of hiccoughs - CORRECT ANSWER Chlorpromazine palliative radiation therapy for brain mets - CORRECT ANSWER External beam radiation palliative radiation therapy for bone mets - CORRECT ANSWER Strontium-89 therapy is an intravenous radionucleotide What is one of the primary challenges of adequate pain management in oncology care? - CORRECT ANSWER patients to have fear that their disease is progressing and either under-report their pain