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Role Development Final Exam Study Guide Test.

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Role Development Final Exam Study Guide Test. Advanced practice registered nurse - CORRECT ANSWER the patient-focused application of an expanded range of competencies to improve health outcomes for patients and populations in a specialized clinical area of the larger discipline of nursing Direct clinical practice - CORRECT ANSWER the central competency of any APN role and informs all the other competencies Four roles of an APRN - CORRECT ANSWER Certified nurse practitioner, certified registered nurse anesthetist, certified nurse midwife, clinical nurse specialist Licensure - CORRECT ANSWER the process whereby an agency of state government grants authorization to an individual to engage in a given profession. For nursing, licensure is usually based on 2 criteria; the application attaining the essential education and degree of competency necessary to perform a unique scope of practice and passing a national exam. Credentialing - CORRECT ANSWER an umbrella term that refers to the regulatory mechanisms that can be applied to individuals, programs, or organizations . Institutional level--the process an individual institution, or health system, uses to permit an APRN to practice in an APRN position within the institution. State level--The requirements that a state uses to assess minimum standards of competency for APRNs to be authorized to practice in an APRN role. Purpose is to protect the health and safety standards of the public. Regulation - CORRECT ANSWER The rules and policies that operationalize the laws and policies that recognize APRNs and credential them for practice in an APRN role and population focus Certification - CORRECT ANSWER A formal process (usually an examination) used by a certifying agency to validate, based on predetermined standards, an individual's knowledge, skills, and abilities. Primary care - CORRECT ANSWER Addresses most health needs across the lifespan, in sickness and in health. Key tasks: first contact with care, longitudinal care, comprehensiveness of care, and coordination of services. Primary care NP - CORRECT ANSWER Educated to provide the full spectrum of health care services to previously diagnosed and undiagnosed primary care patients and families, including health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, and palliative and end-of-life care. "Preventative care" Primary Care - CORRECT ANSWER Medical services are divided into primary, secondary, and tertiary care. Primary focuses on general care for overall patient education and wellness, secondary and tertiary care treat more severe conditions that require specialized knowledge and more intensive health monitoring. Certified nurse midwife educational requirements - CORRECT ANSWER Midwifery education has been more broadly based than nursing, Evan at master's level, degrees may come from nursing, midwifery, public health or allied health schools. to earn AMCB certification as either a CNM or a CM must complete a graduate degree program that has been accredited by the accreditation commission for midwifery education (ACME) Regulated on a state-by-state basis; regulated by boards of nursing in 38 states, recognized as APRNs in 42 states. Certified registered nurse anesthetist educational requirements - CORRECT ANSWER Complete BSN or other appropriate baccalaureate degree, hold current licensure as an RN, complete 1 year of critical care as an RN, graduate with a minimum of a master's degree from an accredited nurse anesthesia program, successfully complete national certification exam offered by the NBCRNA for CRNAs Clinical nurse specialist educational requirements - CORRECT ANSWER role was created to provide direct care to patients with complex diseases or conditions, to improve patient outcomes by developing the clinical skills and judgement of staff nurses, and to retain nurses who were experts in clinical practice, particularly in emerging specialty areas. CNS graduate preparation has not been standardized. Certification is available through the American nurses credentialing center and the AACN certification corporation. the consensus model for aprn regulation requires, at a minimum, advanced pharmacology, and advanced physiology and patho physiology.

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NP Exam: Endocrine Study Guide.

Diabetes Mellitus Type I pathology - CORRECT ANSWER -May occur from childhood to early adulthood

-pancreas makes no insulin

-Strongly associated with human leukocyte antigens HLA-DR3 and HLA-DR4

-Islet cell antibodies found in approx 90% of patients within 1st year of diagnosis

-Ketone development usually occurs from breakdown of protein for energy

-Believed to be the result of an infectious or toxic environmental insult to pancreatic B cells of
genetically predisposed persons



DM 1 signs and symptoms - CORRECT ANSWER -Polyuria

-Polydipsia

-polyphagia

-Nocturnal enuresis

-weight loss

-weakness/fatigue



DM 1 labs/diagnostics - CORRECT ANSWER -Random plasma glucose >200mg/dl with symptoms

-Serum fasting blood sugar >126 mg/dl X 2

-Ketonemia, ketonuria, or both

-BUN/CR elevated from dehydration

-Hgb A1C elevated - greater than 7% (gives indication of glycemic control over last 2-3 months)



Many type 1 DM patients present for first time with DKA



(Same for DM 2 except no ketones in blood/urine)



DM 1 management - CORRECT ANSWER -highly individualized

, -baseline studies for obesity, cardiac risk factors, presence of ketones, diagnostic markers, lipid panel,
ECG, renal studies, peripheral pulses, neurologic function, eye and foot exams

-Dietary teaching - total carbs 55-60%m fats 20-30%, protein 10-20%



Insulin therapy:

-0.5 u/kg/day with 2/3 given in morning and 1/3 in evening

-intensive therapy: reduce or omit PM dose and add a portion at bedtime

-Insulin analogs: aspart (novolog); Glargine (lantus) prolonged duration; Lispro (Humalog) rapid onset



Somogyi Effect in DM 1 - CORRECT ANSWER -Nocturnal hypoclycemia stimulates hormones which raise
blood sugar.

-Patient will be HYPOGLYCEMIC at 3 am and rebound with hyperglycemia at 7 am



Treatment: REDUCE or OMIT the bedtime insulin dose

sOmOgyi - Omit bedtime dose



Dawn Phenomenon in DM 1 - CORRECT ANSWER Tissues become desensitized to insulin at night.

Blood glucose progressively rises through the night, resulting in elevated glucose at 0700.



Treatment: Add or increase the bedtime dose of insulin

Dawn is rising



Type 2 DM pathology - CORRECT ANSWER -Most common type of diabetes. >90% of DM is type 2

-Circulating insulin exists to prevent DKA, but is inadequate

-Either tissue is insensitive to insulin or insulin secretory defect results in insulin resistance or impaired
production

-Not linked to HLA or islet cell antibodies

-Associated with obesity and metabolic syndrome (low HDLs and high triglycerides)

-Slow onset of hyperglycemia, pt may be asymptomatic

-Polyuria, polydipsia
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