Family Nurse Practitioner Clinical Internship III (D124)

Correct answer: c. primary care provider.

Explanation:

For a patient with multiple chronic conditions, including diabetes, hypertension, arthritis, and coronary artery disease, the primary care provider (PCP) serves as the central point of contact for managing overall health. The PCP coordinates care, monitors ongoing health conditions, and makes referrals to specialists as needed. In this case, the primary care provider is the most appropriate first point of contact for the patient to address routine healthcare needs and to ensure the management of all conditions, including diabetes, hypertension, and coronary artery disease.

Why other options are wrong:

a. cardiologist.

While a cardiologist is an important specialist for the management of coronary artery disease, the first point of contact for general healthcare needs should be the primary care provider. The cardiologist would be consulted as needed for specific issues related to the heart, but the PCP is responsible for the overall coordination of care.

b. endocrinologist.

An endocrinologist specializes in conditions related to hormone regulation, such as diabetes. While an endocrinologist is important for managing diabetes, the primary care provider should be the first point of contact for general healthcare needs. The PCP can refer the patient to the endocrinologist if necessary, but for day-to-day health management, the PCP is the primary contact.

d. rheumatologist.

A rheumatologist specializes in the diagnosis and treatment of arthritis and other musculoskeletal diseases. While the rheumatologist is important for managing the patient’s arthritis, the primary care provider should be the first point of contact for overall healthcare coordination and management of the patient’s multiple health conditions. The PCP can then refer the patient to the rheumatologist if needed for arthritis-specific care.

Correct answer:

c. peer review

Explanation:

Peer review is a process where professionals evaluate each other’s work to ensure that it meets the required standards and adheres to established guidelines or protocols. In this case, the family nurse practitioner is reviewing health records to ensure that diabetes care protocols are being followed, which is a clear example of peer review. This process encourages accountability, fosters improvement, and ensures that care provided by healthcare professionals meets the quality standards expected in the healthcare setting.

Why other options are wrong

a. core competency

Core competencies refer to the fundamental skills and knowledge that healthcare providers need to perform their duties effectively. While peer review may involve evaluating competencies, the act of reviewing health records to ensure protocols are followed is not a core competency itself. Core competencies are the essential capabilities that healthcare professionals must have, but peer review is an activity that helps maintain and improve those competencies.

b. force field analysis

Force field analysis is a decision-making tool used to analyze the forces for and against a change in a system. It is not a method for reviewing clinical records or ensuring adherence to protocols. This tool is more commonly used in management and organizational change processes, not in the evaluation of clinical practices such as reviewing health records for adherence to protocols.

d. risk analysis

Risk analysis involves identifying, assessing, and managing potential risks in various aspects of healthcare, such as patient safety, legal issues, or operational risks. While risk analysis can be part of quality improvement, it does not directly describe the process of reviewing health records for protocol adherence. In this scenario, peer review is more accurate because it focuses on evaluating the work of colleagues rather than analyzing risks.

Correct answer

C: psoriasis

Explanation

Psoriasis is a chronic autoimmune condition that leads to the rapid buildup of skin cells, forming scales and plaques. The description of a well-circumscribed erythematous plaque with scales and fissuring is characteristic of psoriasis, particularly in areas of friction, such as the gluteal fold. The nonpruritic nature of the eruption and the long-term intermittent exacerbations over the past 10 years are also consistent with psoriasis. Psoriasis is typically diagnosed based on its appearance, and its chronic course aligns with the patient's history.

Why other options are wrong

A. atopic dermatitis

Atopic dermatitis, also known as eczema, is a common chronic skin condition that often presents with pruritic, inflamed, and itchy lesions. While it can have intermittent flare-ups, the plagues described in this case are not consistent with the typical presentation of atopic dermatitis, which is usually more inflamed and itchy. Psoriasis tends to present with more defined, silvery, scaly patches, which is a more fitting description for the lesion seen in this patient.

B. ichthyosis

Ichthyosis is a group of skin disorders characterized by dry, scaly skin. While ichthyosis can cause scaling of the skin, it does not typically present with well-defined erythematous plaques and fissures in the manner described in this case. Ichthyosis usually results in generalized scaling rather than localized, inflamed plaques, making psoriasis a more likely diagnosis here.

D. tinea corporis

Tinea corporis, also known as ringworm, is a fungal infection that often presents as a ring-shaped lesion with a raised, scaly border. While the presence of scales in this patient's lesion might initially suggest a fungal infection, the erythematous plaque with fissuring is more characteristic of psoriasis. Tinea corporis typically has a more defined ring-like appearance, and the lack of pruritus in this case further distinguishes it from a fungal infection.

Correct answer

C. Nonmaleficence

Explanation

Nonmaleficence is the ethical principle that emphasizes the obligation to do no harm and prevent harm to others. In the context of nursing research, this principle ensures that the nurse researcher takes all necessary precautions to protect participants from harm or exploitation. This includes ensuring that research is conducted with participant safety in mind, providing informed consent, and minimizing any risks associated with the study. The goal is to ensure that participants are not harmed by their involvement in the research process.

Why other options are wrong

A. Confidentiality

While confidentiality is a critical ethical principle in nursing research, it primarily focuses on protecting the privacy of participants and ensuring that their personal information is kept secure. However, confidentiality alone does not specifically address the broader concern of minimizing potential harm or exploitation that is covered by the principle of nonmaleficence. Nonmaleficence goes beyond confidentiality by ensuring that no harm comes to participants as a result of the research process.

B. Justice

Justice in nursing research refers to the fair treatment of participants, ensuring that no group is unfairly targeted or excluded from the benefits of the research. While justice is important, it does not directly address the need to prevent harm, which is the focus of nonmaleficence. Justice ensures fairness, but nonmaleficence specifically protects participants from harm or exploitation during the research process.

D. Right to self-determination

The right to self-determination is an important ethical principle that emphasizes that participants should have the autonomy to make decisions about their participation in research. While this principle is essential for respecting participants' rights, it does not directly relate to preventing harm, which is the core aspect of nonmaleficence. Nonmaleficence ensures that participants are not harmed, regardless of their ability to make autonomous decisions.

Correct answer:

c. long latency period between exposure and disease development

Explanation:

The long latency period between exposure and disease development is a significant challenge in determining occupational exposure to a disease. Many occupational diseases, such as cancer or respiratory disorders, take years or even decades to manifest symptoms. This delay makes it difficult to establish a clear link between the disease and the specific exposure that occurred in the workplace, as the disease may not appear until long after the individual has left the workplace or the exposure has ceased. This prolonged timeline complicates the process of diagnosis, monitoring, and compensation.

Why other options are wrong

a. confidentiality of the information within company records

While confidentiality concerns within company records can pose some challenges in the reporting and tracking of occupational diseases, it is not the most difficult aspect in determining exposure. Often, laws and regulations mandate the protection of workers' health information, but this issue is usually manageable through appropriate legal and health channels. The main issue lies more in the time delay between exposure and the manifestation of the disease, making this option less relevant to the question's focus.

b. inaccuracy of occupational disease reporting

Inaccuracy in reporting occupational diseases does occur but is not the primary difficulty in determining exposure. While data inaccuracies may affect the overall understanding of disease trends, they do not account for the long latency periods that make it hard to associate disease with past workplace exposures. The latency period remains the most significant challenge in establishing a definitive cause-and-effect relationship between exposure and disease.

d. reliance on workers' memories

Reliance on workers' memories may be a factor in some cases, but it is not as critical as the long latency period. Workers may forget or misremember certain exposures, but this issue is secondary to the fact that many occupational diseases take years to develop. Workers’ recollections of exposure events may provide some context but are not as significant in determining disease outcomes as the actual time lapse between exposure and the onset of disease symptoms.

Correct answer:

d. serve as a handbook for best practice

Explanation:

Clinical practice guidelines are evidence-based recommendations designed to provide a systematic approach to care, helping healthcare professionals make informed decisions. These guidelines are intended to standardize care practices and promote the best possible outcomes for patients by offering clear instructions for diagnosis, treatment, and management of various conditions. The goal is not to increase variations in clinical care but to reduce inconsistencies and improve the quality of care by ensuring that healthcare providers follow the most up-to-date and scientifically validated practices.

Why other options are wrong

a. increase variations in clinical care

Clinical practice guidelines are specifically intended to reduce, not increase, variations in clinical care. By offering standardized practices, these guidelines aim to make healthcare more predictable and reliable. Increasing variations would lead to inconsistencies in treatment, which could compromise patient safety and quality of care.

b. mandate practice decisions

While clinical practice guidelines strongly recommend certain practices, they are not meant to mandate decisions. They provide a framework based on the best available evidence, but ultimately, clinical judgment and individual patient needs must guide healthcare providers' decisions. They are tools for guidance, not mandates, allowing for flexibility when necessary.

c. protect nurses from legal liability

While adhering to clinical practice guidelines may help healthcare providers defend their practice in legal situations, the primary purpose of these guidelines is not to protect from legal liability. Their main goal is to improve patient care outcomes by promoting best practices. Relying on guidelines may contribute to legal defense, but it is not their fundamental purpose.

Correct answer:

d. puff out both cheeks

Explanation:

The facial nerve (cranial nerve VII) is responsible for controlling the muscles of facial expression. One way to assess its integrity is by asking the patient to puff out both cheeks. This action engages the buccinator muscle, which is controlled by the facial nerve. If the facial nerve is functioning properly, the patient should be able to puff out both cheeks equally. In cases of facial nerve damage, the patient may have difficulty performing this action, or one side of the face may show weakness or asymmetry.

Why other options are wrong

a. clench their teeth

Clenching the teeth assesses the function of the trigeminal nerve (cranial nerve V), which is responsible for sensation in the face and motor control of the muscles used for chewing. This action does not test the integrity of the facial nerve, so it is not appropriate for assessing facial nerve function.

b. extrude their tongue

Extruding the tongue tests the function of the hypoglossal nerve (cranial nerve XII), which controls the muscles of the tongue. This action is unrelated to the facial nerve, which controls the muscles of facial expression rather than those involved in tongue movement.

c. produce a big yawn

A big yawn may involve several muscles controlled by different cranial nerves, including the facial nerve, but it is not a specific test for facial nerve integrity. More targeted actions, such as puffing out the cheeks or raising the eyebrows, are more reliable in assessing the facial nerve.

Correct Answer:

Ciprofloxacin for 7 days

Explanation:

This presentation is consistent with acute pyelonephritis. Outpatient management of uncomplicated pyelonephritis often includes oral fluoroquinolones such as ciprofloxacin for 7 days, provided local resistance rates are low. This regimen provides effective renal tissue penetration, which is crucial for infection resolution.

Why Other Options Are Wrong:

Trimethoprim-sulfamethoxazole for 3 days

Too short for upper urinary tract infections; inadequate therapy may lead to treatment failure.

Nitrofurantoin for 5 days

Not recommended for pyelonephritis because it does not achieve adequate renal tissue levels.

Single-dose intramuscular ceftriaxone followed by oral therapy

This is an option in certain resistant cases, but ciprofloxacin remains first-line in non-resistant, uncomplicated cases.

Correct answer:

B. Hydrochlorothiazide (Microzide)

Explanation:

Hydrochlorothiazide, a thiazide diuretic, is known to cause an increase in cholesterol and triglyceride levels, which can raise lipoprotein levels in some patients. While it is effective in lowering blood pressure, its potential side effects include increased levels of low-density lipoprotein (LDL) and total cholesterol. These lipid changes are important to monitor, particularly in patients with existing cardiovascular risk factors. Hydrochlorothiazide has been shown to have a more significant effect on lipid levels compared to other diuretics.

Why other options are wrong:

A. Furosemide (Lasix)

Furosemide is a loop diuretic used to treat edema and hypertension. Unlike thiazide diuretics, furosemide does not typically increase lipid levels. Its primary side effects are related to electrolyte imbalances, such as hypokalemia and dehydration, rather than changes in lipoprotein levels.

C. Spironolactone (Aldactone)

Spironolactone is a potassium-sparing diuretic that inhibits aldosterone. It does not have a significant effect on lipoprotein levels. While it can cause hyperkalemia and other electrolyte disturbances, it does not raise cholesterol or triglyceride levels in the same way thiazide diuretics like hydrochlorothiazide do.

D. Triamterene (Dyrenium)

Triamterene is also a potassium-sparing diuretic, like spironolactone, and does not significantly impact lipoprotein levels. It is more commonly associated with hyperkalemia and electrolyte disturbances but does not typically lead to an increase in cholesterol or triglycerides.