Category: Nursing

Technological Advances in Healthcare Essay

Technology in health care has taken many forms over the years. In 1796, Edward Jenner developed the first smallpox vaccination method. A hundred years later, Wilhelm Rontgen discovered how to use x-rays for medical imaging. And in 2013, Japanese researchers grew the first human liver from stem cells. What is next?  How does one technological advance set the stage for further discoveries?

For this assignment you will compose an analysis of 
750-1,000 (STAY WITHIN WORD COUNT)
 words incorporating the following:

Evaluate at a minimum of two different historical perspectives regarding the delivery of health care in the United States. How has technology and the lack of developing technology affected and shaped these perspectives?

Contrast and describe two technological advances that have positively impacted health care delivery in the United States.

Explain how the two technological advances you selected have influenced public opinion of the changing health care system in the United States? Provide a brief summary of both positive and negative opinions.

Forecast how you believe these two technological advances will affect delivery and utilization of health care in the United States in the future. What other factors may simultaneously affect health care utilization?

Prepare this assignment according to the guidelines found in the APA Style Guide.

An abstract is not required.

This assignment uses a rubric 
(
SEE RUBRIC ATTACHMENT
)
. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin 
(SIMILARITY INDEX SHOULD NOT EXCEED 15%)
.

Lack of Mental Health – Nursing and Healthcare Policy paper guidelines

Select a policy related problem (Mine is lack of mental health) that affects of persons, communities or society in general and write a policy issue paper dealing with the problem.  Include problem identification, background information (social, economic, ethical and political/legal factors), the issue statement, stakeholders, policy objectives, policy alternatives or evaluation of options, political feasibility, comparison of alternatives, and the results of your analysis.

*see if there are policies in the legislature either state (IL) or federal that you could compare.

Timeline for the History of Public Health and Epidemiology Essay

Review the Topic Material, “Timeline for the History of Public Health and Epidemiology” to complete this assignment. Using this resource as an example, create your own timeline in a Word document with significant dates that influenced and changed the health care delivery systems.

Your timeline should begin where the timeline in the topic material above ends (1988).

Your timeline should end with the most current and significant information that you can find. You are required to add a minimum of 10 significant dates to this timeline in order to receive a passing grade.

Provide a detailed description for each significant date and event you add to the timeline.

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Use appropriate and scholarly sources in order to complete this assignment successfully, such as peer-reviewed literature and web sources that have .edu, .gov, and .org domain addresses. 
Wikipedia, and most .com sources are not considered to be of sufficient scholarly rigor.

While APA format is not required for the body of this assignment, solid academic writing is expected and
 in-text citations and references should be presented using APA documentation guidelines.

This assignment uses a rubric 
(
SEE RUBRIC ATTACHMENT
)
. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. 
SIMILARITY INDEX SHOULD NOT EXCEED 15%

Timeline for the History of Public Health and Epidemiology Essay Rubric

 

1

Unsatisfactory

59.00%

2

Less Than Satisfactory

65.00%

3

Satisfactory

75.00%

4

Good

85.00%

5

Excellent

100.00%

70.0 %Content

 

35.0 %Current And Significant Dates Added To Timeline from 1988 Onward

Not included.

Current and significant dates are incorporated into the timeline from 1988 onward, but the information provided is incomplete, inaccurate, or otherwise deficient.

Current and significant dates are incorporated into the timeline from 1988 onward, but minimal detail or support is provided for one or more components.

Current and significant dates are incorporated into the timeline from 1988 onward in full. The submission provides appropriate support.

Current and significant dates are incorporated into the timeline from 1988 onward comprehensively. Level of detail is appropriate.

35.0 %Description For Each Significant Date And Event Added To The Timeline

Not included.

A description for each significant date and event added to the timeline is present, but the information provided is incomplete, inaccurate, or otherwise deficient.

A description for each significant date and event added to the timeline is present, but minimal detail or support is provided for one or more components.

A description for each significant date and event added to the timeline is present in full. The submission provides appropriate support.

A description for each significant date and event added to the timeline is present comprehensively. Level of detail is appropriate.

20.0 %Organization and Effectiveness

  

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7.0 %Theme Development and Purpose

Submission lacks any discernible overall purpose or organizing claim.

Submission is insufficiently developed or vague. Purpose is not clear.

Theme of the submission is apparent and appropriate to purpose.

Theme of the submission is clear, descriptive and appropriate to the purpose.

Submission is comprehensive and the purpose and all elements are clear and thorough.

8.0 %Argument Logic and Construction

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.

Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

Writer is clearly in command of standard, written, academic English.

10.0 %Format

 

5.0 %Paper Format (use of appropriate style for the major and assignment)

Template is not used appropriately, or documentation format is rarely followed correctly.

Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

Appropriate template is used. Formatting is correct, although some minor errors may be present.

Appropriate template is fully used. There are virtually no errors in formatting style.

All format elements are correct.

5.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

100 %Total Weightage

Timeline for the History of Public Health and Epidemiology Essay Rubric

Fundamentals of Nursing Exam Questions and Answers

The doctor orders hourly urine output measurement for a postoperative male client. The nurse Trish records the following amounts of output for 2 consecutive hours: 8 a.m.: 50 ml; 9 a.m.: 60 ml. Based on these amounts, which action should the nurse take?

Continue to monitor and record hourly urine output

Irrigate the indwelling urinary catheter

Increase the I.V. fluid infusion rate

Notify the physician

The physician prescribes a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance?

Hypokalemia

Hyperkalemia

Hypernatremia

Hypervolemia

Tony, a basketball player, twists his right ankle while playing on the court and seeks care for ankle pain and swelling. After the nurse applies ice to the ankle for 30 minutes, which statement by Tony suggests that ice application has been effective?

“My ankle appears redder now”.

“I need something stronger for pain relief”

“My ankle looks less swollen now”.

“My ankle feels warm”.

Nurse Trish is caring for a female client with a history of GI bleeding, sickle cell disease, and a platelet count of 22,000/μl. The female client is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hr. The client complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. In administering the medication, Nurse Trish should avoid which route?

Oral

S.C

I.M

I.V

Nurse Gray places a client in a four-point restraint following orders from the physician. The client care plan should include:

Check circulation every 15-30 minutes.

Assess temperature frequently.

Socialize with other patients once a shift.

Provide diversional activities.

The nurse In-charge in labor and delivery unit administered a dose of terbutaline to a client without checking the client’s pulse. The standard that would be used to determine if the nurse was negligent is:

The actions of a reasonably prudent nurse with similar education and experience.

The physician’s orders.

The statement in the drug literature about administration of terbutaline.

The action of a clinical nurse specialist who is recognized expert in the field.

A newly admitted female client was diagnosed with deep vein thrombosis. Which nursing diagnosis should receive the highest priority?

Excess fluid volume related to peripheral vascular disease.

Ineffective peripheral tissue perfusion related to venous congestion.

Impaired gas exchange related to increased blood flow.

Risk for injury related to edema.

 

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 including 
Fundamentals of Nursing Exam Questions and Answers

 

Nurse Labs is assigned to the following clients. The client that the nurse would see first after endorsement?

A 44 year-old myocardial infarction (MI) client who is complaining of nausea.

A 34 year-old post operative appendectomy client of five hours who is complaining of pain.

A 26 year-old client admitted for dehydration whose intravenous (IV) has infiltrated.

A 63 year-old post operative’s abdominal hysterectomy client of three days whose incisional dressing is saturated with serosanguinous fluid.

A male client who has severe burns is receiving H2 receptor antagonist therapy. The nurse In-charge knows the purpose of this therapy is to:

Enhance gas exchange

Prevent stress ulcer

Facilitate protein synthesis.

Block prostaglandin synthesis

Dr. G writes the following order for the client who has been recently admitted “Digoxin .125 mg P.O. once daily.” To prevent a dosage error, how should the nurse document this order onto the medication administration record?

“Digoxin 0.125 mg P.O. once daily”

“Digoxin .125 mg P.O. once daily”

“Digoxin .1250 mg P.O. once daily”

“Digoxin 0.1250 mg P.O. once daily”

She finds out that some managers have benevolent-authoritative style of management. Which of the following behaviors will she exhibit most likely?

Communicates downward to staffs.

Have condescending trust and confidence in their subordinates.

Allows decision making among subordinates.

Gives economic and ego awards.

Nurse Amileen is aware that the following is true about functional nursing

One-to-one nurse patient ratio.

Provides continuous, coordinated and comprehensive nursing services.

Emphasize the use of group collaboration.

Concentrates on tasks and activities.

Fundamentals of Nursing Exam Questions and Answers

A male client is admitted and diagnosed with acute pancreatitis after a holiday celebration of excessive food and alcohol. Which assessment finding reflects this diagnosis?

Blood pressure above normal range.

Hyperactive bowel sounds

Sudden onset of continuous epigastric and back pain.

Presence of crackles in both lung fields. – Given

A male client is receiving total parenteral nutrition suddenly demonstrates signs and symptoms of an air embolism. What is the priority action by the nurse?

Place the client in high-Fowlers position.

Notify the physician.

Stop the total parenteral nutrition.

Place the client on the left side in the Trendelenburg position. – Given

Nurse Michelle witnesses a female client sustain a fall and suspects that the leg may be broken. The nurse takes which priority action?

Immobilize the leg before moving the client.

Takes a set of vital signs.

Reassure the client that everything will be alright.

Call the radiology department for X-ray.

A newly admitted female client was diagnosed with agranulocytosis. The nurse formulates which priority nursing diagnosis?

Diarrhea

Risk for infection

Deficient knowledge

Constipation

Which type of medication order might read “Vitamin K 10 mg I.M. daily × 3 days?”

Standing order

Stat order

Single order

Standard written order

Which instruction should nurse Tom give to a male client who is having external radiation therapy:

Protect the irritated skin from sunlight.

Eat 3 to 4 hours before treatment.

Apply lotion or oil to the radiated area when it is red or sore.

Wash the skin over regularly.

Which dietary guidelines are important for nurse Oliver to implement in caring for the client with burns?

Monitor intake to prevent weight gain.

Provide high-protein, high-carbohydrate diet.

Provide ice chips or water intake.

Provide high-fiber, high-fat diet

A male client is being transferred to the nursing unit for admission after receiving a radium implant for bladder cancer. The nurse in-charge would take which priority action in the care of this client?

Encourage the client to take frequent rest periods.

Place client on reverse isolation.

Admit the client into a private room.

Encourage family and friends to visit.

In assisting a female client for immediate surgery, the nurse In-charge is aware that she should:

Explore the client’s fears and anxieties about the surgery.

Encourage the client to void following preoperative medication.

Encourage the client to drink water prior to surgery.

Assist the client in removing dentures and nail polish.

A female client with a fecal impaction frequently exhibits which clinical manifestation?

Increased appetite

Hard, brown, formed stools

Liquid or semi-liquid stools

Loss of urge to defecate

Nurse Hazel will administer a unit of whole blood, which priority information should the nurse have about the client?

Blood pressure and pulse rate.

Height and weight.

Calcium and potassium levels

Hgb and Hct levels.

Nurse Marlon prepares to perform an otoscopic examination on a female client. For proper visualization, the nurse should position the client’s ear by:

Pulling the helix up and back

Pulling the helix up and forward

Pulling the lobule down and forward

Pulling the lobule down and back

Nurse Nam attends an educational conference on leadership styles. The nurse is sitting with a nurse employed at a large trauma center who states that the leadership style at the trauma center is task-oriented and directive. The nurse determines that the leadership style used at the trauma center is:

Autocratic.

Laissez-faire.

Democratic.

Situational

Fundamentals of Nursing Exam Questions and Answers

Diabetes Mellitus Questions and Answers

A client with diabetes mellitus visits a health care clinic. The client’s diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia?

Prednisone (Deltasone)

Allopurinol (Zyloprim)

Atenolol (Tenormin)

Phenelzine (Nardil)

Rotating injection sites when administering insulin prevents which of the following complications?

Insulin resistance

Systemic allergic reactions

Insulin lipodystrophy

Insulin edema

Insulin forces which of the following electrolytes out of the plasma and into the cells?

Phosphorus

Potassium

Magnesium

Calcium

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:

Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.

Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals.

Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream.

A client with type 1 DM has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should:

Call the physician

Encourage the intake of fluids

Give the client ½ c. of orange juice

Administer the insulin as ordered

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse’s priority is to provide:

Fluid replacement

Oxygen

Carbohydrates

Dietary instruction

When a client is in diabetic ketoacidosis, the insulin that would be administered is:

Human regular insulin

Human NPH insulin

Insulin glargine injection

Insulin lispro injection

The nurse expects that a type 1 diabetic may receive ____ of his or her morning dose of insulin preoperatively:

25-40%

10-20%

50-60%

85-90%

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?

Elevated blood glucose level and a low plasma bicarbonate

Comatose state

Decreased urine output

Increased respirations and an increase in pH

The lowest fasting plasma glucose level suggestive of a diagnosis of DM is:

90mg/dl

126mg/dl

115mg/dl

180mg/dl

A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse?

BP

Temperature

Respiration

Pulse

A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: 1. High risk for d

Imbalanced nutrition: less than body requirements

Deficient knowledge: disease process and treatment

Disabled family coping: compromised

High risk for deficient fluid volume

Knowing that gluconeogenesis helps to maintain blood levels, a nurse should:

Document weight changes because of fatty acid mobilization

Do all of the above

Protect the patient from sources of infection because of decreased cellular protein deposits

Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue insulation

Which of the following chronic complications is associated with diabetes?

Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia’s

Retinopathy, neuropathy, and coronary artery disease

Leg ulcers, cerebral ischemic events, and pulmonary infarcts

Dizziness, dyspnea on exertion, and coronary artery disease

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to:

Apply an electrocardiogram monitor

Correct the acidosis

Administer 5% dextrose intravenously

Administer regular insulin intravenously

Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection?

No changes

More insulin

Less insulin

Oral antidiabetic agents

Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except:

Hypoglycemia

Hyponatremia

Ketonuria

Polyphagia

Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis?

IV bolus, followed by continuous infusion

Intramuscular

IV bolus only

Subcutaneous

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?

Give subcutaneous insulin and monitor blood glucose

Monitor blood glucose, and assess for signs of hyperglycemia

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?

Monitor blood glucose closely, and look for signs of hypoglycemia

Albert refuses his bedtime snack. This should alert the nurse to assess for:

Symptoms of hyperglycemia during the peak time of NPH insulin.

Signs of hypoglycemia earlier than expected.

Elevated serum bicarbonate and a decreased blood pH.

Sugar in the urine

 

A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of:

16-20 hours

6-8 hours

24-28 hours

10-14 hours

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The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says:

“I need to rub my forearm vigorously until warm before testing at this site.”

“The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.”

“I have to make sure that my current glucose monitor can be used at an alternate site.”

“Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels.”

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client’s anxiety would be to:

Make sure the client knows all the correct medical terms to understand what is happening

Administer a sedative

Convey empathy, trust, and respect toward the client

Ignore the signs and symptoms of anxiety so that they will soon disappear

A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?

Shallow respirations and severe abdominal pain

Cheyne-stokes respirations and foul-smelling urine

Decreased respirations and increased urine output

Kussmaul’s respirations and a fruity odor on the breath

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every:

Week

Third day

2-3 weeks

2-4 weeks

A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse’s primary responsibility to:

Assist the client out of bed to the chair

Check the client’s serum glucose level

Place the client in a high-fowlers position

Ensure that the client’s residual limb is elevated

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise?

“The best time for me to exercise is after breakfast.”

“The best time for me to exercise is every afternoon.”

“The best time for me to exercise is after my morning snack.”

“The best time for me to exercise is right after I eat.”

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except:

Observation for paleness of the lower extremities

Palpation for increased pulse volume in the arteries of the lower extremities

Integumentary inspection for the presence of brown spots on the lower extremities

Observation for blanching of the feet after the legs are elevated for 60 seconds

Glucose is an important molecule in a cell because this molecule is primarily used for:

Synthesis of protein

Extraction of energy

Building of genetic material

Formation of cell membranes

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:

Weakness

Nausea

Diaphoresing

Blurred vision

The insulin that has the most rapid onset of action would be:

Lispro

Humulin N

Lente

Ultralente

The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply.

Palpitations

Thirst

Hyperventilation

Diaphoresis

Slurred speech

Which adaptations should the nurse caring for a client with diabetic ketoacidosis expect the client to exhibit? Select all that apply:

Low PCO2

Sweating

Acetone breath

Elevated serum bicarbonate

Retinopathy

A client with DM states, “I cannot eat big meals; I prefer to snack throughout the day.” The nurse should carefully explain that the:

Large meals can contribute to a weight problem

Small, frequent meals are better for digestion

Regulated food intake is basic to control

Salt and sugar restriction is the main concern

Albert, a 35-year-old insulin dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

1530 and 2130

1330 and 1930

1730 and 2330

1130 and 1330

A client’s blood gases reflect diabetic acidosis. The nurse should expect:

Decreased HCO3

Decreased PO2

Increased PCO2

Increased pH

The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order. 1. Inject air equal to NPH dose into NPH vial 2. Invert regular insulin bottle and withdraw regular insulin dose 3. Inject air equal to regular dose into regular dose 4. Invert NPH vial and withdraw NPH dose.

1, 4, 3, 2.

1, 2, 3, 4.

1, 4, 2, 3,

1, 3, 2, 4.

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it:

Provides more storage of glucose

Increases blood glucose levels

Stimulates the release of insulin

Inhibits gluconeogenesis

Which of the following causes of HHNS is most common?

Undiagnosed, untreated diabetes mellitus

Removal of the adrenal gland

Undiagnosed, untreated hyperpituitarism

Insulin overdose

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is:

6-14 hours after administration

2-4 hours after administration

18-24 hours after administration

16-18 hours after administration

Get in touch for the answers to the above Diabetes Mellitus Questions and Answers

Health Care Management Homework

Here is the assignment:

Get out your ACA One-Pager you completed before Fall Break. Review the three (3) covered services      you chose for each of the three (3) groups: Services for Adults; Services for Women,      Including Pregnant Women and Services for Children. Next, pick out any state in the United      States and report a health status indicator associated with each of the      three (3) services you chose. Try      to use the most current secondary health data you can find.

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For the United States I suggest using the website below:

http://www.americashealthrankings.org/

http://www.countyhealthrankings.org/

-health status associated with the Service for Adults; (10 points)

-health status associated with the Service for Women; and, (10 points)

-health status associated with the Service for Children. (10 points)

What is your state doing (what is going on in your state or a local      community/ies) to promote the utilization of each of the Preventive Health      Services you chose and are covered in the Affordable Care Act?

-health status associated with the Service for Adults; (20 points)

-health status associated with the Service for Women; and, (20 points)

-health status associated with the Service for Children. (20 points)

Provide a 3-5 minute presentation in class (10 points)

Psychopharmacology – Psychiatry Questions and Answers

1. 
Tricyclic antidepressants are contraindicated in:

A. Glaucoma

B. Brain tumour

C. Bronchial asthma

D. Essential hypertension

 

2. 
Which of the antipsychotic drugs has a prolonged action?

A. Trifluperazine

B. Thioridazine

C. Penfluridol

 

D. Fluphenazine

3. 
The congenital anomaly produced by lithium therapy is:

A. Limb shortening

B. Anencephaly

C. Heart block

D. Renal agenesis

About 10 percent of newborns exposed in 1st tri­mester of pregnancy had major congenital malforma­tions. The most common is Epstein’s anomaly of the tricuspid valves. Lithium is not indicated in a lactating woman. Signs of is toxicity in infants include lethargy, cyanosis, abnormal reflexes, rarely hepatomegaly.

4. 
All the following are side-effects of Fluoxetine, except:

A. Weight gain

B. Sweating

C. Urinary retention

D. Diarrhea

 

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5. 
Akathisia is treated by all the following, except:

A. Trihexyphenidyl

B. Diazepam

C. Haloperidol

D. Promethazine

6. 
Prophylactic maintenance of serum level of lithium is:

A. 0.2-0.8 mEq/L

B. 0.7-1.2 mEq/L

C. 1.2-2.0 mEq/L

D. 2.0-2.5 mEq/L

7. 
The treatment of choice in depression with suicidal ten­dencies is:

A. Tricyclic antidepressants

B. MAO inhibitors

C. Fluoxetine

D. Electroconvulsive therapy

The first and most important indication for ECT is depression with suicidal tendencies.

8. 
The drug not used for prophylaxis of MDP is:

A. Carbamazepine

B. Sodium valproate

C. Chlorpromazine

D. Lithium

Antipsychotics are used as adjuvant in the treatment of mood disorders.

9. All the following are true about clozapine, except:

A. Used in schizophrenia

B. Precipitates seizures

C. Agranulocytosis

D. Extra pyramidal side-effects

The only FDA approved indication for clozapine is as a therapy for treatment resistant schizophrenia. Clozapine suppresses the abnormal movements of TD (Tardive dyskinesia) as does treatment with conventional antipsychotics.

Other indication: Clozapine may treat the movement disorder. Clozapine is more potent on Dl, D3, D4, and 5HT2 receptors in comparison to other typical antipsychotic which are more potent over D2 receptors. Animal models show that clozapine is more active over meso-limbic pathway than nigro- striatal pathway because of which we notice less EPS.

10. 
Which of the following is not an antidepressant?

A. Trazodone

B. Amitriptyline

C. Fluoxetine

D. Pimozide

11. 
Carbamazepine is used in all the following except:

A. Mania

B. Alcohol withdrawal

C. Schizophrenia

D. Trigeminal neuralgia

But recent data indicates that CB2 can be used in schizophrenia and Schizo-affective disorders. Other indications are:

Recurrent depressive disorder

Impulse control disorder v

PTSD (post-traumatic stress disorder)

Alcohol /benzodiazepine withdrawal

Severe blood dyscrasias occur in about 1 in 125,000 pts treated with Carbamazepine.

12. 
A patient of schizophrenia treated for 5 years, developed abnormal movement. The patient has:

A. Tardive dyskinesia

B. Muscular dystonia

C. Akathisia

D. Malignant neuroleptic syndrome

TD delayed effects of antipsychotic caused by dopamine receptor super sensitivity in basal ganglia. Serotonin – dopamine antagonists may be used in pts with TD.

13. 
The mechanism of action of Fluoxetine is:

A. Serotonin reuptake inhibitor

B. MAO-B inhibitor

C. Nor adrenaline reuptake inhibitor

D. Benzodiazepine antagonist Other SSRI are:

Fluvoxamine Sertraline

Paroxetine

Citalopram

Escitalopram

Serotonin norepinephrine reuptake

Inhibitors:

1. Venlafaxine

2. Sibutramine

Atypical antipsychotics: (serotonin dopamine antagonists)

Risperidone

Olanzapine

Quetiapin

Sertindole

Ziprasidone

Clozapine (dibenzodiazepine)

Central presynaptic 2 – adrenergic receptor antagonist – clonidine

Mirtazapine (tetracyclic antidepressant)

14. 
An irritable urge to move about with inner restlessness is called:

A. Akathisia

B. Akinesia

C. Hyperkinesia

D. Dyskinesia

15. 
The drug of choice for rapid cycle MDP is:

A. Lithium

B. Carbamazepine

C. Sodium Valproate

D. Haloperidol

16. 
A 35-year-old female on chlorpromazine for 10 years schizophrenia complains of hearing voices. The loud­ness of the voices of taking chlorpromazine but not stop completely. The best treatment is:

A. Clozapine

B. Haloperidol

C. Tianeptine

D. Sulpiride

Clozapine, the only FDA approved drug for treatment resistant schizophrenia.

17. Tianeptine is a:

A. Selective serotonin reuptake enhancer »

B. Selective serotonin reuptake inhibitor.

C. Selective norepinephrine reuptake inhibitor

D. Norepinephrine agonist

Tianeptine – Norepinephrine serotonin selective reuptake enhancers

Venlafaxine – Norepinephrine serotonin reuptake inhibitor

MAOI-Hydroxide – a. Phenelezine b. isocarboxazide Norhydroxide – a. tranylcypromine Reversible selective

MAOls

MAOI – B – Selegiline

MAOI – A – Moclobamide

Broforamine Irreversible selective MAOI: clorgyline

Sympathomimetic stimulants:

1. Dextroamphetamine

2. Methylphenidate

Mood Stabilizers:

1. Lithium

2. Carbamazepine

3. Sodium valproate

4. Topiramate

5. Lamotrigine

6. Clonazepam

18. 
A 50-year-old man has presented with pain in back, lack of interest in recreational activities, low mood, lethargy, decreased sleep, and appetite for 2 months. There is no history suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness. There was no family history of psychiatric illness. Routine investi­gations including hierogram, renal function tests, elec­trocardiogram, did not reveal any abnormality. This pa­tient should be treated with:

A. Haloperidol

B. Sertraline

C. Alprazolam

D. Olanzapine

(The only antidepressant in this group)

Clinical history suggests that the patient is depressed.

19. 
Carbamazepine was first used in:

A. Depression

B. MDP

C. Anxiety

D. All of the above

Carbamazepine is an antimonies and mood stabilizing agent. It is a tricyclic compound synthesized in 1953 by Schindler.

20. 
The treatment of choice for acute or abrupt onset de­pression includes:

A. Lithium

B. Tricyclic antidepressants

C. MAO inhibitors

D. Electroconvulsive therapy

21. 
In acute mania, the therapeutic serum level of lithium
 includes:

A. 0.2 – 0.5 mEg/L

B. 0.8-1.5 mEq/L

C. 1-2 mEq/L

D. 2-5 mEQ/L

22. 
Antipsychotic drug to be avoided especially in first tri­mester of pregnancy:

A. Chlorpromazine

B. Haloperidol

C. Carbamazepine

D. Lithium

i. Neurological – Tremor, muscle weakness, cogwheel rigidity, seizures, neurotoxicity.

ii. Renal – Polyuria, polydipsia, tubular changes nephrogenic diabetes insipid nephritic syndrome.

iii. CVS – Hypokalemia, T wave depression.

iv. Endocrine – Goiter, hypothyroidism, abnormal thyroid function, weight gain.

v. GIT – Nausea, vomiting, diarrhea, abdominal pain, metallic taste.

vi. Dermatological-Acne form eruptions, popular eruptions, exacerbation of psoriasis.

vii. During pregnancy of lactation-teratogenic, increased incidence of Ebstein’s anomaly also created in milk with 30 to 100 percent of maternal blood hi level. Cause toxicity in infant. Contraindications of lithium we are cardio renal, thyroid, neurological dys­function blood dyscrasias, during first traumata of pregnancy and lactation, concomitant administration of theorize diuretics, tetracycline, or anesthetics.

23. Lithium is used in psychiatry to treat:

A. Hysteria

B. Phobia

C. Mood disorders

D. Acute organic brain syndrome Indications of lithium in psychiatry:

Acute mania

Prophylaxis of bipolar mood disorders

Schizoaffective disorder

Impulsive aggression.

24. 
Clozapine is a:

A. Atypical antipsychotic

B. Anti-anxiety drug

C. Used in dementia

D. Also known as disulfiram

Other atypical antipsychotics – Risperidone, olanzapine, ziprasidone.

Also remember – Clozapine is the drug of choice in treatment-resistant schizophrenia.

25. 
Paroxetine is a:

A. Antipsychotic drug

B. Used in opiate poisoning

C. Tricyclic antidepressant

D. Selective serotonin reuptake inhibitor

Others SSRI’s

Paroxetine, fluvoxamine, fluoxetine, sertraline, citalopram

Also remember –

SSRI with longest half-life-fluoxetine

SSRI with shortest half-life-fluvoxamine

26. 
Imipramine is mainly used as a:

A. Sedative

B. Tranquilizer

C. Antidepressant

D. All of the above

Remember – imipramine is the first antidepressant to be introduced.

27. 
Nausea is a troublesome side effect of the following an­tidepressant:

A. Doxepine

B. Fluoxetine

C. Trazodone

D. Mianserin

Other side effects: Insomnia, akathisia, loss of appetite, sexual dysfunction.

28. 
Which antidepressant found to be associated with tar­dive dyskinesia and narcoleptic malignant syndrome?

A. Amoxapine

B. Trazodone

C. Fluoxetine

D. Amineptin

This is because of blockade of dopamine receptors in the striatum.

29. 
Blood levels of neuroleptics are useful to check the fol­lowing:

A. Toxicability

B. Therapeutic levels

C. Resistance

D. All of the above

Clozapine and haloperidol levels are important to monitor toxicities.

30. 
The drug of first choice in weight reduction programme
 is:

A. Amphetamine

B. Phenylethlamine

C. Fenfluramine

D. Diethyl propion

31. 
Therapeutic range of lithium is:

A. 0.5 to 1 mmol/1

B. 0.8 to 1.4 mmol/1

C. 1.4 to 2.5 mmol/1

D. 1.0-2.6 mmol/1

Remember toxicity – if level > 2.0 mEq/1

Life threatening intoxication – > 3.5 mEq/1

32. 
Akathisiais:

A. Neurotic disease

B. Seen in schizophrenia

C. Side effect of lithium

D. Side effect of antipsychotic drugs.

Akathisia manifests as motor restlessness. It is due to blockade of dopamine type-2 receptors in striatum.

33. 
Neuroleptic malignant syndrome is characterized:

A. Bradycardia

B. Labile hypertension

C. Hypotonia

D. Hypothermia

Feature of NMS – fever, elevated, EPS, catatonic symptoms, autonomic dysfunction

34. 
Akathisia is treated by:

A. Haloperidol

B. Fluoxetine

C. Propranolol

D. Lithium

Drug of choice – Propranolol. Benzodiazepines are useful.

35. 
Feature of akathisia is:

A. Cogwheel rigidity

B. Oculogyric crisis

C. Restlessness

D. Periodic movements

Motor restlessness is the key feature of akathesia Cogwheel rigidity occurs in parkinsonism Oculogyric crises is an acute dystonia Perioral movements could be rabbit syndrome or Tardier dyskinesia.

36. 
Malignant neuroleptic syndrome is treated by:

A. Dantrolene

B. Diazepam

C. Haloperidol

D. Chlorpromazine Bromocriptine can also be used.

37. 
Side effect of clozapine is:

A. Within one week – neutropenia

B. Dl- ve, D2 +ve

C. Agranulocytosis

D. Excitement

Clozapine must be stopped immediately.

38. 
The drug of choice for obsessive-compulsive disorder is:

A. Haloperidol

B. Clomipramine

C. Amitryptilline

D. Diazepam

Dose of Clomipramine – 75 to 300 mg 1 day.

39. 
Lithium is used in all except:

A. Endogenous depression

B. Recurrent attacks of mania

C. Schizoaffective psychosis

D. Paranoid psychosis

40. 
Side effect of chlorpromazine for which anti cholinergic is used:

A. Blurred vision

B. Oculogyric crises

C. Hypotension

D. Dry mouth

41. 
Newer nonsedative, nonhypnotic anxiolytic is:

A. Alprazolam

B. Buspirone

C. Lorazepam

D. Diazepam

Buspirone acts as a partial against at 5HTIA receptor. It doesn’t have anticonvulsant and muscle relaxant properties.

42. 
The drug of choice for panic disorders is:

A. Imipramine

B. Nitrazepam

C. Clonidine

D. Diazepam

Small doses of antidepressants are used (imipramine and fluoxetine).

136 Psychiatry Question Bank for PG Entrance Exams

43. 
In drug induced parkinsonism, benzhexol has got no role
 in:

A. Sialorrhea

B. Tremor

C. Akathisia

D. Rigidity

Akathisia is treated with P blockers and benzodiazepines (propranolol).

44. 
In fluoxetine and imipramine, the main difference is in:
 –

A. Less side effects

B. Onset of action

C. Effect of OCD

D. Duration of action

 

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45. 
Which of the following drug has the minimum extra py­ramidal side effect?

A. Clozapine

B. Metoclopramide

C. Reserpine

D. Trifluperazine

46. 
Which of the following drugs produce rapid induction of sleep with least influence of sleep architecture?

A. Zaleplon

B. Diazepam

C. Chlorpromazine

D. Haloperidol

Dosage of zaleplon 5 to 10 mg

As it has a half-life of one hour it is useful in initial insomnia

47. 
All of the following are antidepressants, except:

A. Imipramine

B. Amitryptilline

C. Risperidone

D. Citalopram

Imipramine and amitryptilline are tricyclic anti­depressants; citalopram is a SSRI risperidone is an atypical antipsychotic.

48. 
Which of the following side effects of chlorpromazine are ameliorated by anticholinergic antiparkinson medi­cation?

A. Confusion

B. Hypotension

C. Blurred vision

D. Oculogyric crisis

49. 
Lithium is used to treat:

A. Hysteria

B. Phobia

C. Mood disorders

D. Acute organic brain syndrome

50. 
Lithium is used in:

A. Acute mania

B. Depression

C. Hyperkinetic disorder

D. All of the above.

51. 
The least affected organ in lithium toxicity is:

A. Liver

B. Heart

C. Kidney

D. Brain

There is no hepatic metabolism for lithium in body.

52. 
Treatment of Panic attack includes the use of:

A. Diazepam

B. Imipramine

C. Fluoxetine

D. Clonazepam

E. Bothb + c

Both imipramine and fluoxetine in small doses are useful in treating panic disorder

53. 
All the following are anxiolytic except:

A. Fluoxetine

B. Buspirone

C. Diazepam

D. Nitrazepam

Fluoxetine is an antidepressant. It acts by selecting serotonin reuptake inhibition

54. 
Lithium is treatment of choice for:

A. Unipolar MDP prophylaxis

B. Bipolar MDP

C. Schizophrenia

D. Acute mania

Lithium is indicated in prophylaxis of bipolar MAP and acute mania.

55. 
The most useful drug in enuresis is:

A. Haloperidol

B. Diazepam

C. Imipramine

D. Chlorpromazine

Imipramine is the drug of choice in nonorganic enuresis usual dose range is 25 to 75 mg 1 day.

56. 
The least extra pyramidal effect is seen with:

A. Haloperidol

B. Thioridazine

C. Clozapine

D. Chlorpromazine

Drugs with minimal EPS are clozapine, quetipin sulpiride and ziprasidone.

Drugs useful in Heroin withdrawal are clonidine, methadone, buprenorphin, LAAM, and dextropropoxyphene.

57. 
Long-term therapy of lithium causes:

A. Neutropenia

B. Hypothyroidism

C. Hepatotoxicity

D. Bone narrow depression

Long-term lithium use causes renal side-effects also.

58. 
All of the following are selective serotonin (5HT) reuptake inhibitors, except:

A. Fluvoxamine

B. Fluoxetine

C. Paroxetine

D. Olanzapine

SSRI’s are fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram.

59. 
A psychiatric patient on tricyclic antidepressants presents with bradycardia, hypotension, decreased sweating, and retention of urine. The most likely drug used is:

A. Amitryptilline

B. Fluoxetine

C. Selegiline

D. Lithium

Decreased sweating, retention of urine, bradycardia are anticholinergic side effects of amitryptilline, hypotension is due to Ll-adrenergic blockade.

60. 
A 63-year-old man who is taking amitryptilline suddenly develops confusion, urinary retention and blurring of vi­sion. The cause is:

A. Anticholinergic side-effects

B. Reactive depression

C. Emergence of negative symptoms

D. CVA

61. 
A patient was found stuporous and he did not eat or sleep the whole day. On examination, he was found to be con­scious. The treatment should be: (AIIMS-2000)

A. ECT

B. Antipsychotics

C. Antidepressants

D. Neuroleptic

62. 
30-year-old Bano Begum was brought to the casualty is a state of altered sensorium. She was on lithium treat­ment for the affective disorder and suffered an attack of epileptic fits. On examination she has tremors, increased deep tension reflexives, and insentience of urine. She also had undergone an episode of severe gash enteritis 2 days ago. Lithium level in the serum is 1.95 mEq/l. The most likely cause is:

A. lithium toxicity

B. severe dehydration

C. Manic stupor

D. Epileptic fits

63. 
The most common cardiac abnormality associated with use of lithium in 1st trimester of pregnancy:

A. Deacon’s syndrome

B. Epstein’s anomaly of tricuspid valve

C. PDA

D. Coarctation of aorta

In Epstein’s anomaly there is a distortion and down ward displacement of tricuspid valve. Use of lithium is contraindicated in the 1st trimester of pregnancy.

64. 
Vasanti, 45-year-old, was brought to casualty with ab­normal movements which included persistent deviation of the meek to the right side. One day earlier, she had been prescribed haloperidol 5mg three times daily by the psychiatrist. She also had an altercation with her bush and recently. Which of the following is the most likely cause for her symptoms?

A. Acute drug dystonia

B. Conversion reaction

C. Acute psychosis

D. Cerebrovascular accident.

Acute dystonia is an acute extra pyramidal symptom caused by antipsychotic medication. In this case, the neck muscles are affected by dystonia.

65. Contraindications to lithium administration include:

A. An administration in combination with chlorpromazine

B. The presence of renal disease

C. Any occurrence of the symptoms of schizophrenia

D. The presence of depression

E. An administration in combination with imipramine.

 

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Kidney Stone Pathophysiology Essay – Porth’s Pathophysiology: Concepts of Altered Health States

Fred, a fit and healthy 44-year-old, was working outside one warm summer afternoon. When he returned home by the end of the day, his lower back felt sore and he felt nauseated. His wife made him dinner, but he was not hungry and chose to go to bed instead. Fred’s symptoms progressed, and soon he was rolling on the bed with excruciating pain. He said his back hurt as well as his stomach and groin area. The pain would ease off only to return a short while later, and when it did, Fred would begin to sweat and run to the bathroom to vomit. His wife became concerned and she helped him into the car and rushed him to the hospital.

Please answer the following questions and submit your assignment via Blackboard by the due date.

1. At the hospital, an abdominal radiograph showed the presence of renal calculi in Fred’s right ureter (urolithiasis).  What is the pathophysiological mechanism of stone formation in the kidney?

2. In the hospital, Fred’s urine is being strained for the presence of stones that he may have passed. What is the importance of this action?

3. What are the 4 primary types of renal calculi and what are the risk factors for each of these types of renal calculi?

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4. Hydronephrosis can be a complication of renal calculi. Why is hydronephrosis such a serious complication?

5. View the following youtube video entitled “How do kidney stones form?”   

Identify two key points that you learned about renal calculi in the video?

This is the grading  criteria : 

Grading:
Subject Knowledge and Accuracy (6 points)

Normal physiological principles, processes, and mechanisms are explained at the molecular, cellular, and organ levels.

Physiological processes and mechanisms relating to the pathology are clearly explained.

Answers focus on substantive ideas that are supported by relevant facts and examples.

Explanations are clear and incorporate appropriate vocabulary.

Thoughtful and convincing responses clearly demonstrate depth of subject knowledge.

Information is derived from good quality, credible sources.

All questions are answered completely.

All content is current and accurate.

Bibliography / Citations / Writing (3 points)

Two (2) or more sources used for the assignment (your textbook can be one of the sources).

All material that is not considered “common knowledge” is cited.

All quotations and/or paraphrasing are cited according to APA format.

The full reference for each citation is found in the bibliography.

References are listed alphabetically at end of assignment in the bibliography.

Bibliography and citations follow APA format.

Writing is free of grammatical errors.

Sentences are complete, clear, and concise.

Spelling is correct.

This book should be used as reference also:

Porth’s Pathophysiology: Concepts of Altered Health States (9th edition) 
ISBN-13:
 978-1451146004
ISBN-10:
 1451146000

Answers

1.A 2.D 3.C 4.A 5.C 6.B 7.D 8.C 9.D 10.D 11.C 12.A 13.A 14.A 15.A 16.A 17.A 18.B 19.B 20.A 21.B 22.D 23.C 24.A 25.D 26.C 27.B 28.A 29.A 30.D 31.B 32.D 33.B 34.C 35.C 36.A 37.C 38.B 39.D 40.B 41.B 42.A 43.C 44.A 45.A 46.A 47.C 48.D 49.C 50.A 51.A 52.E 53.A 54.D 55.C 56.C 57.B 58.D 59.A 60.A 61.C 62.A 63.B 64.A 65.B