NSG 555/ NSG555 Exam 1 V2 – Nurse Practitioners in Primary Care II Review| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

NSG 555/ NSG555 Exam 1 V2 – Nurse Practitioners in Primary Care II Review| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A Circle of Caring Represents attributes of nursing that APRN's Blend with medical and nursing knowledge to reach a patient in a holistic manner -Courage -Authentic presence -Advocacy -Knowing _Commitment - Patience Health Belief Model predicts whether and why people will take action to prevent, detect or control health conditions. Applies to behaviors with the potential to reduce risk of developing a disease as well as effects of existing condition System Management Model Depicts symptom management as dynamic relationships between 3 key concepts: -Symptom Experience -Symptom Management Strategies -Symptom Outcomes All nested within in 3 domains of nursing science (Person, Environment, and health/illness) that influence and surround all 3 dimensions of symptoms, thus signifying the contextual considerations for nursing research. Integrated Theory of Health Behavior Change Suggest that health behavior can be enhanced by fostering knowledge and beliefs, increasing self-regulation, and abilities, and enhancing social facilitation. Spirit Focused Conceptual Model Views the person as a spiritual being whose life and purpose arise from a personal relationship with God. The individual's definition of God determines how he or she responds to stimuli, sets goals, and establishes purpose in life. Theoretical Model of Change 6 Stages -Precontemplation -Contemplation -Preparation Determination -Action -Maintenance -Termination Theoretical Model of Change - Precontemplation People do not intend to take action on the foreseeable future (next 6 months). Often unaware their behavior is problematic or produces negative consequences. People underestimate the pros of changing behavior and place too much emphasis on the cons of changing that behavior. Theoretical Model of Change - Contemplation People intend to start the health behavior in the foreseeable future (within 6 months). Recognize behavior is problematic, and a more thoughtful and practical consideration of the pros/cons of changing behavior takes place with equal emphasis on both. Theoretical Model of Change - Preparation Determination People ready to take action in the next 30 days. Take small steps to behavior change to lead a healthier life. Theoretical Model of Change - Action People recently changed behavior (within 6 months) and keep moving forward with the behavior change. People exhibit by modifying their problem behaviors or acquiring new healthy behaviors. Theoretical Model of Change - Maintenance People have sustained the behavior change for a while (6 months or more) and intend to maintain the change forward. Preventing relapse is a goal. Theoretical Model of Change - Termination People have no desire to return to previous unhealth behaviors and are sure they will NOT relapse. Since this is rarely reached and people tend to stay in the maintenance stage, this is not often considered in health promotion programs. Health Literacy a person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness Primary Prevention True prevention that lowers the chances that a disease will develop Ex: Vaccines, Education/counseling for high-risk behavior, Exercise, stress reduction, nutrition counseling, eliminating allergen exposure Secondary Prevention Efforts to limit the effects of an injury or illness that you cannot completely prevent. Ex: Screening programs (mammograms for breast cancer, LDCT for Lung Screening, DEXA for osteoporosis) teritary prevention people who already have the disorder (prevents worsening or rolls back symptoms) Ex: Diabetes - Control of blood sugar, excellent skin care, frequent examination of feet, frequent exercise to prevent heart and blood vessel disorders) Stroke - Taking ASA to prevent 2nd stroke Providing supportive and rehab services to prevent deterioration and maximize quality of life, such as rehab form injuries, heart attack or stroke Preventing complications in people with disabilities, such as preventing pressure sores in those confined to a bed. Define Evidence Based Practice sequential and structured approach for integrating the best available evidence into the decision making process Purpose of EBP is to Incorporate evidence into health-care delivery using a systematic problem-solving approach that integrates: - a review and appraisal of the best research evidence - The practitioners clinical expertise - The patients or populations preferences, values, concerns and socioeconomic factors influencing care What is the purpose of practice guidelines? Practice guidelines are recommendations for clinical practice based on the best available evidence. They are developed by organizations such as the US preventative services task force (USPSTF) Level 1 Evidence Hierarchy systematic reviews, meta-analysis, EBP guidelines Level II Evidence Hierarchy evidence obtained from LESSER quality daignostic studies, prospective studies, systemic reviews, or randomized controlled trails. AT LEAST ONE WELL-DESIGNED RCT Level III Evidence Hierarchy controlled trials without randomization (quasi-experimental) Level IV Evidence Hierarchy Evidence from well-designed case-control or cohort studies Level V Evidence Hierarchy Evidence from a systematic review of descriptive and qualitative studies (meta-syntheses) Level VI Evidence Hierarchy Single descriptive or qualitative study Level VII Evidence Hierarchy Evidence from the opinion of authorities and/or reports of expert committees. Main component in billing E & M Codes (level of service is based on?) Chief complaint, History (HPI, ROS, PMH/PFH, SH), Physical Exam, medical decision making (problems, data, risk) & Time Define Medical Decision Making Process by which a diagnosis or treatment plan is formulated from the available test information, often with incorporation of known patient preferences. 3 components (problems, data and Risk) Each component has different levels -low/limited = level 3, moderate = level 4, and high/extensive = level 5 Highest level reached by at least 2 out of the 3 components determines the correct code for the level of service. What is required in order to bill a level of service based on time? Total time, includes all the time you spend on a visit on the day of the encounter. Time you spend after the visit: Documentation Ordering Reviewing Studies Refilling Making calls DOES NOT included time spent performing seperately bill services such as wellness visits or procedures. Total time visit level threholds differ for new vs established patients Expected weight gain during pregnancy Low BMI ( 19.8) 28-40lbs gain Normal BMI (19.9-26) 25-35lb gain High BMI (26.1-29) 15-25lbs gain Obses BMI (29) 15lbs gain Screening for STI's in pregnancy & when? Initial Assessment -Chlamydia, Gonorrhea, Syphillis, HIV, Hep B HERPES- not recommended unless high risk 28 weeks -Syphillis (if at increased risk d/t geography or personal risk) 3rd Trimenster - Chlamydia (for women under 25 or at risk), Gonorrhea (for women under 25 or at risk) HIV (if at high risk) Heartburn in Pregnancy Eat small bland meals - avoid late night meals Raise HOB and avoid lying flat Chewing gum might help If needed OTC antacids (Gaviscon), Tagamet, Zantac (reintroduced with Famotidine as the ingredient NOT ranitidine), or Omeprazole are all safe in pregnancy Naegle's rule - estimate due date *BE Careful of THE YEAR!!!!!* Begin with the first day of the LMP (first day) Subtract 3 months, and add 7 days EDC, EDD,EDB - Estimated date of birth,confinement, delivery -doptone (+ 10-12 weeks) -Fetoscope (heard at 18 weeks) -Fetal Movement (Quickening) 18-24 weeks -US PPD At least 5 depressive symptoms are present for at least 2 weeks, onset up to 12 months postpartum -Depressed mood (subjective or observed) is present most of the day -Loss of interest or pleasure (anhedonia), most of the day -Sleep disturbances (insomnia or hypersomnia) -Psychomotor retardation or agitation -Worthlessness or guilt -Loss of energy or fatigue -Suicidal ideation or attempt and recurrent thoughts of death -Impaired concentration or indecisiveness -Change in weight or appetite (weight change of 5% over 1 month) R/F for PPD Traumatic or stressful life events Lack of social support Previous or family history of depression Difficulties becoming pregnant Being a parent to twins or multiples Teen mom Preterm labor, which occurs before 37 weeks of pregnancy Pregnancy and birth complications Tx for PPD Psychiatry - CBT or other forms of Talk therapy Antidepressants - safe while pregnant Support groups Adjustments to diet or exercise Meditation or other mindfulness practices PPP (Psychosis) Medical Emergency - develops suddenly and involves the risk of life-threatening complications. A diagnosis of postpartum psychosis is considered when symptoms similar to that of PPD develop through abruptly and at a very high intensity. R/F for PPP History & Genetics - + FamHx of having Personal hx of PPD. bipolar depression or schizophrenia increase likelihood of an episode Hormone levels and disturbed sleep patterns Traumatic birth or pregnancy Tx for PPP Ideally admitted with baby to special psychiatric hospital call mother baby unit Hospitalizations will usually required for a few days to weeks, or until symptoms are relieved and mood stabilized, such as no longer at risk to self or baby Tx Meds for PPP Antipsychotics - Risperidone, Ziprasideone, Olanzapine and arpiprazole -help to decrease hallucinations. Mood Stabilizers - Prevent/Relieve mania - Lithium, Lamotrigine, carbamazepine, divalproex sodium Antidepressant - relieve sadness, anxiety and suicidal tendencies Psychosocial Therapy - CBT, counseling, talking therapy aimed at providing support for patients, helping manage stress and anxiety by modifying thinking and behavior ECT - LAST choice when all other therapy failed placenta previa PAINLESS- implantation of the placenta over the cervical opening or in the lower region of the uterus DO NOT DO PELVIC EXAM (LIFE THREATENING HEMORRAGE, DIGITAL RECTAL/VAGINAL EXAMS CONTRAINDICATED - as the cervix changes, and prepares for delivery -placenta tears and causes the bright red bleeding - Usually seen after week 30 -presents with closed cervical o and scant blood in the vaginal vault, soft nontender uterus -pelvic rest and avoiding strenuous activity Tx of Hypertension in pregnancy Hydralazine, labetalol, methyldopa, nifedipine First line Tx is alpha agonist Methyldopa at 250mg BID titrating up, but watch for sedation. Avoid ACEi/'s and ARBs. Avoid Diuretics since they can decrease plasma volume in the patient Beta Blockers - Labetolol is GOOD Watch for preeclampsia BP Ranges in pregnancy Chronic HTN BP 140/90 before 20 weeks Gestational HTN BP becomes 149/90 after 20 weeks Preeclampsia - Elevated BP 140/90 after 20 weeks with protein in urine Tx of UTI/Cystitis Monitor urine - treat both symptomatic and asymptomatic Untreated UTI's lead to complications such as pyelonephritis, preterm birth, low birth weight, and even maternal sepsis, highlighting the importance of prompt diagnosis and management -Amoxicillin -Augmentin -Cephalexin Avoid Bactrim/Nitrofurantoin near pregnancy because they increase r/o hyperbilirubinemia. Cause hemolysis in patients or fetuses with Glucose-6 Phosphate dehydrogenase deficiency. Trimethoprim is also relatively contraindicated during 1st trimester of pregnancy because its teratogenic as a result of its antifolate activity. Symptoms of pre-eclampsia Headache Visual disturbance or blurriness Nausea and vomiting Upper abdominal or epigastric pain (this is due to liver swelling) Heartburn Reduced urine output Brisk reflexes BP 140/90 Proteinuria Seizures = Eclampsia How to diagnosis Preeclampsia 24 hour urine for proteinuria, CBC (r/o thrombocytopenia), CMP (look at elevated LFT's to r/o HELLP), UA with C & S (look for protein and r/o UTI)