Mrs. A. is an 84-year-old woman who was recently discharged from the hospital with a diagnosis that includes an exacerbation of congestive heart failure (CHF). She also has diabetes and hypertension. Mrs. A. was discharged from the hospital on multiple medications and lives alone. Home care services were initiated with skilled nursing care visits, some home health aide support, and orders to include daily telemonitoring of her vital signs. The telehealth device will remotely monitor Mrs. A.’s blood pressure, heart rate, oxygen saturation, and weight. In addition, the patient will answer customized questions about her disease on a daily basis. This information will then be transmitted daily to the home care agency, where the telenurse can determine appropriate clinical actions based on the data trends and preset baseline alerts that indicate when set parameters have been exceeded.

• What assessment information in the patient situation is the most important and of immediate concern for the nurse?
• What patient condition(s) are consistent with the most relevant information?
• Which possibilities or explanations are most likely to be present in the patient situation? Which are the most serious or a priority?
• What actions would most likely achieve the desired outcome for this patient?
• Which actions are the most appropriate and how should they be implemented?
• What patient assessment would indicate your actions were effective

Pharmacology

The physician prescribes Nexium (Esomeprazole) for a patient who is suffering from gastric ulcer. The nurse should give the medication:

1 point

A. After lunch

B. Before bedtime

C. 30 mins before the meal

D. 60 mins after the meal

Clear selection

A nurse caring for patient receiving pancreatic enzymes as replacement therapy should be assessing the patient for

1 point

a) Hypertension

b) Cardiac arrhythmias

c) Excessive weight gain

d) Signs of GI irritation

Clear selection

Mary is 24 weeks pregnant and she has been complaining of a burning sensation in her chest. The physician prescribed an antacid. Which one of the following is an antacid?

1 point

A. Zantac

B. Maalox

C. Nexium

D. Pantecta

Clear selection

Misoprostol (cytotec) is a prostaglandin ordered for patients to

1 point

a) Prevent uterine contractions

b) Prevent NSAID-related gastric ulcers in patients at high risk

c) Decrease hyperacidity with meals and at bedtime

d) Relieve the burning associated with hiatal hernia at night.

Clear selection

When the nurse is administering a proton pump inhibitor(PPI), which action by the nurse is correct?

1 point

a) Giving the PPI on an empty stomach

b) Giving the PPI with meals

c) Instructing the patient to open the capsule and chew the contents for best absorption.

d) Administering the PPI only when the patient complains of heartburn

Clear selection

What is the drug action of lubricants?

1 point

A. When there is a need to increase the motility of the GI tract.

B. When a thorough evacuation of the intestine is desirable.

C. To make defecation easier without stimulating the movements of the GI tract

D. To slow down the motility of the tract to make defecation more effective

Acid rebound is a condition that occurs when

1 point

a) Lowering gastric acid to an alkaline level stimulates the release of gastric acid

b) Raising gastric acid levels causes heartburn

c) Combining protein, calcium, and smoking greatly elevates gastric acid levels

d) Eating citrus fruit neutralizes gastric acid.

Clear selection

The patient will have the best therapeutic results if Sucralfate is taken:

1 point

A. Before bedtime

B. With lunch

C. One hour after a meal

D. One hour before meals

Mr. Johnson has not had a bowel action in 3 days. A bulk stimulant was ordered for him. Which of the following is an example of bulk stimulant?

1 point

a) Epsom salts

b) Milk of magnesia

c) Metamucil (psyllium)

d) All of the above

Which statement is INCORRECT about Histamine 2 receptor antagonist?

1 point

A. Ranatidine (Zantac) and Cimetidine (Tagamet) are examples of H2 receptor antagonist.

B. It is a popular class of drug for the treatment of peptic ulcer disease.

C. H2 blockers block histamine which causes the chief cells to decrease the secretion of hydrochloric acid.

D. H2 blockers block histamine receptors on the parietal cells which inhibits the production of gastrin and hydrochloric acid.

A nursing student asked her nurse- in- charge of serving medication about the indication for serving Histamin-2 Antagonists medication, her response:

1 point

a) Long term treatment of active duodenal ulcer

b) Long term treatment of benign gastric ulcer

c) Treatment of erosive gastroesophageal reflux

d) All of the above

Histamine-2 Antagonists is one class of drugs used to treat gastroesophageal reflux disease and ulcer disease in humans, an example of this drug is

1 point

a) Omeprazole

b) Cimetidine

c) Misoprostol

d) Sucralfate

Clear selection

What is the drug action of a proton pump inhibitor?

1 point

A. It increases the production of hydrochloric acid.

B. It increases the production of pepsin and gastrin

C. This drug works by forming an ulcer adherent complex at the duodenal ulcer site which protects it from acids, pepsin and bile salts.

D. Acts by directly inhibiting the release of the hydrogen–potassium adenosine triphosphatase (H+, K+-ATPase) enzyme system, thereby inhibiting the production of hydrochloric acid.

Clear selection

Bulk stimulants are a class of drugs that treats short-term constipation and it works by:

1 point

A. By blocking dopamine receptors and making the GI cells more sensitive to acetylcholine, which leads to increased GI activity and rapid movement of food through the upper GI tract.

B. These drugs form a slippery coat on the contents of the intestinal tract; less water is absorbed out of the stool, and the stool is less likely to become hard or impacted.

C. Directly stimulates the nerve plexus in the intestinal wall, causing increased movement and the stimulation of local reflexes.

D. They absorb water into the intestine, which increases bulk and distends the bowel to initiate reflex bowel activity, thus promoting a bowel movement.

A bulk stimulant will be ordered for clients:

1 point

a) When there is a need to increase the motility of the GI tract.

b) When a thorough evacuation of the intestine is desirable

c) To make defecation easier without stimulating the movements of the GI tract

d) To slow down the motility of the tract to make defecation more effective

Clear selection

Mr. Harrison has not had a bowel action in 4 days. A bulk stimulant was ordered for him. Which of the following is an example of bulk stimulant?

1 point

A. Tums

B. Glycerin

C. Dulcolax

D. Milk of Magnesia

Clear selection

Which one of the following instructions is fundamental for the nurse to give to the client who is taking Omeprazole?

1 point

A. Take the tablet whole and do not crush.

B. Dissolve the tablet in water and then consume.

C. Instruct patient to eat only two large meals for the day.

D. Crush the tablet and set it aside for ten minutes before swallowing.

Which of the following antacids is the oldest drug in this group, is readily available in many preparations including as an injectable for treating systemic acidosis

1 point

a) Calcium salts

b) Aluminum salts

c) Magaldrate

d) Sodium bicarbonate

Clear selection

A patient who is taking oral tetracycline complains of heartburn and requests an antacid. Which action by the nurse is correct?

1 point

a) Give the tetracycline, but delay the antacid for 1 to 2 hours

b) Give the antacid, but delay the tetracycline for at least 4 hours

c) Administer both medications together

d) Explain that the antacid cannot be given while the patient is taking the tetracycline

Clear selection

Name *

Which one of the following will prohibit the use of Cytotec?

1 point

A. A pregnant woman

B. A patient who had open heart surgery

C. A patient who had a hip replacement

D. A patient who recently had a lower respiratory tract infection.

Clear selection

Laxative or cathartic drugs is ordered for clients:

1 point

a) When there is a need to increase the motility of the GI tract.

b) When a thorough evacuation of the intestine is desirable

c) To make defecation easier without stimulating the movements of the GI tract

d) To slow down the motility of the tract to make defecation more effective

Clear selection

Proton Pump Inhibitors is another class of drugs used to treat gastroesophageal reflux disease and ulcer disease in humans, an example of this drug is

1 point

a) Omeprazole

b) Cimetidine

c) Misoprostol

d) Sucralfate

Email *

This drug works primarily by neutralizing gastric acidity. They do not prevent the over production of acid but instead help neutralize acid secretions.

1 point

A. Histamine 2 receptor antagonist

B. Antacids

C. Proton pump inhibitors

D. GI protectants

A client is diagnosed with a duodenal ulcer. The physician prescribes Sucralfate. Which statement made by the nurse correctly explains the action of this medication?

1 point

A. This drug blocks the release of hydrochloric acid in response to gastrin.

B. This drug works by forming an ulcer adherent complex at the duodenal ulcer site which protects it from acids, pepsin and bile salts.

C. This drug directly inhibits the release of the hydrogen–potassium adenosine triphosphatase (H+, K+-ATPase) enzyme system.

D. This drug neutralizes the stomach acid by directly affecting the chemical reaction by increasing the pH.

A patient had an open-heart surgery post-op day 4 and the patient complains that he is constipated. Which of the following drug will be ordered by the cardiologist in order to alleviate the constipation?

1 point

A. Lactulose

B. Lomotil

C. Imodium

D. Maalox

Quiz Questions

Antacids that lead to diarrhea:

1 point

Magnesium hydroxide

Sodium bicarbonate

Aluminum hydroxide

Calcium bicarbonate

Mrs. George is travelling to go to Atlanta for a conference. However, she gets anxious when she has to travel by plane and as a such she has been having diarrhea. Which drug can be prescribed to Mrs. George in order to inhibit the diarrhea? *

1 point

B. Imodium

D. Glycerin

C. Dulcolax

A. Calcium salts

A client has been prescribed with chronic pancreatitis has been prescribed with Pancrelipase (Pancrease), which is a pancreatic enzyme. Which of the following symptoms would prompt the nurse that the medication is having its therapeutic effect?

1 point

A. Constipation

B. Excessive diarrhea

C. More bulk in the stool

D. Decrease fat in the stool

All of the following are non-systemic antacids except?

1 point

Aluminum hydroxide

Magnesium hydroxide

Magnesium Trisilicate

Sodium Bicarbonate

What is the most appropriate drug that should be prescribed to a person who suffers from nausea and vomiting while travelling in a vehicle?

1 point

A. Nexium

B. Gravol

C. Maxalon

D. Maalox

All of the following ulcer healing drugs work by inhibiting acidity in the stomach EXCEPT

1 point

Sucralfate

Antimuscuranics

H2 receptor blockers

Antacids

Clear selection

Lactulose is an example of:

1 point

Bulk forming agent

Stimulant purgative

Osmotic purgative

Stool softener

Clear selection

Mr. Ford has been experiencing some discomfort while passing stool for the past two weeks. He is going to have a colonoscopy tomorrow. What medication should be given to Mr. Ford the day before surgery in order to ensure that the colon is free of any stool? *

1 point

A. Kytril

B. Maalox

C. Dulcolax

D. Lactulose

Esomeprazole acts by inhibiting:

1 point

H+NA+ATpase

H+K+ATpase pump

Any of these

H+pump

Clear selection

Gynecomastia is a side effect of which one of the following H2 receptor blocker?

1 point

Ranitidine

Famotidine

Cimetidine

Nazatidine

Which one of the following conditions is a contraindication for the administration of Maxalon?

1 point

A. Urinary tract infection

B. Gastrointestinal bleeding

C. Upper respiratory tract infection

D. Lower respiratory tract infection

Clear selection

Proton pump are most effective when they are given:

1 point

During prolonged fasting periods

After meals

Along with H2 blockers

Shortly before meals

Clear selection

Mr. Moore has been diagnosed with appendicitis. Which one of the following class of drugs should NOT be prescribed to Mr. Moore? *

1 point

B. Antibiotic

D. Proton pump inhibitor

A. Laxative

C. Analgesic

Despite their short half lives (2 hours) proton ump inhibitors cause a long surpression of acid secretion up to 48 hours because:

1 point

They are prodrugs and undergo activity gradually

They are available as enteric coated capsules, from which drug is gradually released

They irreversibly inhibit the proton pump molecule, and hence acid secretion requires synthesis of new proton pumps.

When mixed with water their half life is prolonged

Mrs. Bentley has recently started chemotherapy and has not been eating her meals because she has been feeling nauseous and vomits frequently after she eats her meals. What is the best drug that should be prescribed for Mrs. Bentley?

1 point

A. Nexium

B. Maalox

C. Maxalon

D. Omeprazole

Who are better drivers’ males or females?

Here are some relevant statistics from the data in 2015:

a) Exploratory Data Analysis

• Presence of data analysis and graphs
• Discussion of results and how this led to claim

b) Hypothesis test elements   

• Claim, null, alternative, significance level
• Test stat formula and result including p-value
• Graph, critical value and region, comparison with stat and p-value
• Conclusion
• Interpretation

In a 150 words or more,Should an employee who acts unethically be terminated from his or her position? Why or why not?

A psychologist is interested in knowing whether adults who were bullied as children differ from the general population in terms of their empathy for others. On a questionnaire designed to measure empathy, the mean score for the general population is 30.6. Random sampling of 25 scores obtained from individuals who were bullied yielded a sample mean of 39.5 and a sample standard deviation of 6.6.

Test at the .05 level of significance.

Set up the criteria for making a decision. That is, find the critical value using an

alpha = .05. (Make sure you are sign specific: + ; - ; or ± )

​​​​​Case Study (60): This is the case of Kimmy, a newborn female from Tondo, Manila, who was seen last January 2020 because of physical deformities. Kimmy was born to a 35-year-old G3P3 (3003) mother who had prenatal check-up (PNCU) at the local health center for the first 5 months of pregnancy before moving to a government hospital for her PNCU for the rest of her pregnancy. She had cough and colds during the second trimester and a recurrent urinary tract infection during the third trimester of pregnancy. An ultrasound done during the 5th month revealed polyhydramnios. Her mother also experienced preterm labor at 7 months and was subsequently admitted at the hospital for observation. She was released eventually. The mother denies any family history of diseases and malformations. Kimmy was delivered full term via normal spontaneous delivery and assisted by an obstetrician. The four core steps of Unang Yakap were observed. At birth, she had good cry and good activity with an APGAR score of 8 and 9. Upon physical examination, the following were noted: frontal bossing, low set ears, micrognathia, overlapping of the fingers, ambiguous genitalia, and rocker-bottom feet. The rest of the physical examination was normal. Kimmy was eventually discharged and was advised to undergo laboratory tests including karyotyping. Upon follow-up at the out-patient department, complete blood count showed normal levels. Kimmy’s mother showed the following result to the doctor:

1. What is your diagnosis and what are the salient features of the case that made you arrive at such diagnosis?
2. What are the different clinical manifestations of the diagnosis?
3. Are there laboratory procedures that can be done to detect genetic disorders intrauterine? If yes, please enumerate and explain these procedures.
4. How is this genetic disorder different from the other genetic disorders?
5. What is the prognosis of Kimmy?

Bambi is an artist who makes unique sculptures from a combination of rare gems and recycled materials. He entered into a contract with Atas Art Galleries and Restaurants (“Atas”), to sell his sculptures to Atas.

The contract does not state what Atas intends to do with the purchased sculptures. Atas wanted a simple contract so that Bambi can focus on making and delivering the sculptures. Bambi presumed that Atas could either be displaying his sculptures in its restaurants or selling them in its art galleries.

The contract is for a period of five (5) years and provides that payment of $200,000 shall be made for each sculpture. Clause 5 of the contract states that “Bambi shall supply a minimum of one (1) sculpture every month throughout the duration of the contract.”  

In the first year of the contract, Bambi supplied a total of twelve (12) sculptures. However, in some months, he supplied no sculptures and in some other months, he supplied more sculptures on a per-month basis than were stipulated in the contract.   

At the beginning of the second year of the contract, Atas wrote an email to Bambi, stating as follows:

“We refer to Clause 5 of the contract.

As you have committed a repudiatory breach of a condition of the contract, we hereby exercise our right to immediately terminate our agreement.”  

Bambi was shocked when he read the email. He had just purchased $500,000 worth of rare gems to be used for the sculptures that he was preparing to deliver for that second year.

In addition, he recently rented a large bungalow for 12 months. He felt that the contract with Atas was bringing him an excellent stream of income and he could afford to reside in more comfortable accommodations. If he terminates the lease now, he would have to forfeit his deposit of three (3) months’ rental.

Question 2

Bambi claims that his losses include the costs of purchasing the rare gems and the forfeiture of three (3) months’ rental deposit.

A) Assuming that he is successful in proving that Atas wrongfully terminated the contract, explain the four (4) aspects of damages which Bambi must consider if he wishes to claim for damages. Conclude with your view on what are the likely damages for which Bambi can claim.

A magazine provided results from a poll of 1500 adults who were asked to identify their favorite pie. Among the 1500 ​respondents, 11% chose chocolate​ pie, and the margin of error was given as plus or minus 4percentage points. What values do ModifyingAbove p with caret​,ModifyingAbove q with caret n, E, and p​ represent? If the confidence level is 99%, what is the value of alpha?