AANC Clinical Nurse Specialist (CNS) 2024 Exam Review Questions and Answers 100% Pass, Exams of Clinical Medicine

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AANC Clinical

Nurse Specialist

(CNS) 2024 Exam

Review Questions

and Answers 100%

Pass

AANC Clinical Nurse Specialist (CNS)

2024 Exam Review Questions and

Answers 100% Pass

Conceptualization of CNS role - Answer>> domains of practice spheres of influence 1.Patient/client- Evidence based care incorporating best practice

2. Nurses & Nursing practice- staff education to improve care outcomes
3. Organizations/ Systems- safe, cost effective, quality care delivered across the care continuum Flo Jo - Answer>> Founder of modern nursing Major concepts: nursing, person, health and environment believe environment influenced health first nurse researcher - scientific inquiry and statistics Primary Prevention - Answer>> PREVENTING a disease process example: exercising, smoking cessation Secondary Prevention - Answer>> SCREENING Example: mammograms, pap, cholesterol screening Tertiary Prevention - Answer>> TREATING/ Therapy

develop plan of care evaluate outcomes Maslow Hierarchy of basic needs - Answer>> 1.BASIC: Food, shelter 2.SAFETY: security, door locks, lighting, employment resources

3. BELONGING: love, comfort, family, friends
4. TRUST: control over lifestyle, pain, choices
5. SELF-ESTEEM: Status, pride, confidence 6.SEL-ACTUALIZATION: Satisfying relationships, values, creativity, self-direction Erik Erikson: Developmental Stages - Answer>> 1.ADOLESCENT: Identify vs Role confusion 2.YOUNG ADULT: Intimacy vs isolation
6. MIDDLE AGE: Generavity vs stagnation 4.OLDER Adults: Integrity vs Despair R.J. Havighurst- Developmental Tasks of Aging - Answer>> 1. adjusting to loss 2.Adapting to change
7. Accepting life's experiences
8. Undergoing role changes
9. Preparing for death Community Assessment - Answer>> Assessment of physical, psychological, sociological and environmental aspects of community

design appropriate interventions evaluate outcomes Risk Assessment - Answer>> Importance of risk assessment in PREVENTION of illness/complications can't be overstated assessment tools: braden scale, fall risk, VTE Risk assessment Risk Assessment: CNS Role - Answer>> -Continual assessment -Collects data -Develops individualized differentials -Evaluates and adjusts plan of care to improve outcome -Prepares patients prior to stressful procedures to relieve stress/anxiety Needs Assessment Methodologies - Answer>> -Secondary Data use -Focus groups -in-depth interviews -community forums/public meetings -Surveys Steps in Needs Assessments - Answer>> 1. Determine Population

2. Review/collect subjective/objective data about target population
3. conducts root-cause analysis Needs Assessment/ Gap Analysis - Answer>> Goal is to improve care by implemented best practices based on research evidence Needs Assessment is best way to identify Gaps

elderly- slightly decreased adult values Hematocrit - Answer>> Male: 42-52% Female: 37-47% Pregnancy: >33% MCV (Mean Corpuscular Volume) - Answer>> Average VOLUME & SIZE of erythroCYTES/RBCs Normal/Normocytic: 80- *Can have normocytic anemia: -anemia of CHRONIC disease -sickle Cell -Renal Failure -blood loss -Hemolysis Low MCV - Answer>> Low/ Microcytic: < differential dx: -Iron deficiency Anemia -thalassemia High MCV - Answer>> High/Macrocytic: > differential dx: -B12 deficiency -Folate Deficiency -ETOH

-Liver Failure -Drug effects MCHC (Mean corpuscular Hemoglobin Concentration) - Answer>> Normal 32-36% HYPOchromic <32% HYPERchromic >36% Chromic=color Total WBC - Answer>> Normal 5,000-10,000/mm Plt - Answer>> adult/elderly 150,000-400,000/mm Critical values <50,000 or >1.000, NA+ - Answer>> Normal- 135-145 meq/l Panic: <125 or > K+ - Answer>> Normal 3.5-5meq Panic <3 or > Chloride - Answer>> 98-107 meq/l CO2 - Answer>> Normal 20-29meq/l

may indicate: -DKA -Dehydration -Calorie deprivation Culture - Answer>> Beliefs of a group learned over time & passed to subsequent generations Cultural Values - Answer>> Time honored beliefs of a group Cultural competence - Answer>> ability to understand a different culture & provided individualized, appropriate care Madeleine Leininger - Answer>> Mother of TRANSCULTURAL NURSING -response to illness rooted in cultural beliefs Culturally diverse nursing care - Answer>> appropriate and competent care for patients from many cultures -each pt and each care provider is member of their own cultural group Transcultural Assessment - Answer>> Includes info about biological, psychological, sociological, spiritual & environmental factors specific to the culture of the patient Muslims - Answer>> -Foundational Beliefs- 5 pillars of Islam -women wear modest clothes -Family is more important than the individual

-Violence is denounced by the majority of those practicing Muslim African-American Culture - Answer>> General mistrust d//t past experience (Tuskegee) -Religion plays major role in their lives -Inequality & oppression still exist toward this culture -May use alternative forms of healthcare- natural remedies, ritual, voodoo Mexican American Culture - Answer>> Spanish- primary language -Family plays central role in culture -Catholic Religion, large families are common -Time perception/ time management- difference in importance -May use alternative healthcare practices Native Americans - Answer>> 500 recognized tribes in US Most live on reservations Family groups live in close proximity Epidemics in culture: -Type II DM -Obesity Modern healthcare is at odds with their belief system

Population >85years is fastest growing segment of population 65-74 years - Answer>> the "YOUNG" Old 75- 84 years - Answer>> the "Middle" Old 85-99 years - Answer>> the "OLD" Old

100 years - Answer>> the "ELITE" Old Health promotion for all adults - Answer>> Medication:

Pneumovax after age 50, tetanus booster Q10yrs Health promotion- seat belts, stop smoking. moderate alcohol intake Environmental issues: Smoke detectors, eliminate fall hazards For older adults: avoid OTCs, avoid polypharmacy, Aspirin daily Nutrition in elderly - Answer>> Protein-caloric malnutrition may occur ↑ dietary intake of calcium, vitamin D & vitamin C sedentary lifestyle + reduced metabolic rate= decreased caloric needs Nutrition Issues - Answer>> -↓ in taste & Smell -Dental Problems -Incontinence issues -Mobility Issues -Outcome of nutritional issues= ANOREXIA & WEIGHTLOSS

Late Life Depression (LLD) - Answer>> -Not a normal part of aging -Affects 15% elders >65 yrs old -Affects 50% NH Residents

• LLD may be relapse of earlier life depression -treatable -1St occurrence can be r/t NH placement, illness, hospitalization, bereavement -often undiagnosed Suicide rate highest among older adults

85 yrs=2x the national rate Delirium - Answer>> Cognitive IMPAIRMENT -RAPID ONSET -clouding of consciousness -difficulty shifting & sustaining attention -Brief duration but prolonged if not dx -Drowsy & fluctuating in alertness -common with dementia -May have memory impairment, disorientation, hallucinations,

delusions, disturbed thinking Dementia - Answer>> -PROGRESSIVE Decline in cognitive abilities -GRADUAL ONSET -Multiple cognitive impairments

Dementia Assessment - Answer>> -Hx: from patient and close observers -Focused physical exam -Mini Mental Exam -LABS: CBC, BMP, TSH, Vit b13, serial test for syphilis -Brain CT or MRI -PET Scan -SPECT Scan -MRSI (Advanced MRI Imaging) Dementia Non-pharmalogical Tx - Answer>> -Social Activities -adequate sleep -Adherence to strict schedule -Maintain proper stimulation level -adequate hydration -reforming task (Occupational therapy) -support for caregivers cholinesterase Inhibitors - Answer>> Dementia TX -Can't reverse Alzheimer's -Doesn't stop underlying destruction of cells -losses effectiveness over time -works best in early-middle stages most common: donepezil (ARICEPT) galantamine (RAZDYNE) Rivastigimine (EXELON) Memantine (Namenda) - Answer>> -Tx Moderate to severe Alzheimer's

-May experience better results when combined with cholinesterase Inhibitors Health Belief Model - Answer>> developed by US psychologists Addresses individuals perception of: -Threat -benefit -Intervening factors help predict public attitudes and actions around health issues Health Belief Model: Perceived Susceptibility - Answer>> - the person's assessment of the likelihood of them getting the given condition.

• example, they are younger and believe that the condition afflicts mainly older people, then they will be less likely to act to protect themselves. -Education may correct misunderstandings about susceptibility, which is often grossly incorrect, typically due either to social folklore or individual denial. Health Belief Model:Perceived Severity - Answer>> - the person's view of how severely they would be impacted if they were affected by the condition. -The most severe health impact is death, followed by disablement and pain. Duration is also important: a short, sharp pain may be preferable to a long ache. -education can be specific about severity, including probabilities of survival and disablement.

-Staff Education -system level revision of practice Continuous & overlapping process w/o discrete beginning or end Promoting a culture of change - Answer>> -continuous movement -Leader Support -Critical Inquiry -Address personal concerns -Multiple, innovative processes to show administrative support Lewin's 3 step Change Therory - Answer>> 1. Unfreeze of existing situation or status quo

2. Movement
3. Re-freezing Miller & Rollnick's Motivational Interviewing - Answer>> goal- oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence 4 basic interaction skill: OARS: -Open ended questions -Affirmations -Reflective listening -Summaries Miller & Rollnick's Motivational Interviewing: Principles - Answer>> Non- judgmental -Empathy -Argument Avoidance Self-efficacy support -resistance reframing

-Discrepancy awareness Miller & Rollnick's Motivational Interviewing: Steps - Answer>> - Assessment fosters rapport -Planning clarifies specific change, identifies ambivalence -Implementation- identifies positive movement towards change -Evaluation- analyzes what is working and shifts the focus if it is not Prochaska's Trans theoretical model of change - Answer>> Behavior change evolves through different stages -stage are not linear: Progression and regression through stages occur Stage: 1.pre-contemplation- lack of acceptance, denial of problem

2. contemplation- acknowledgement
3. preparation-Re-evaluation of self commitment to change
4. action-Initiation of change, may take months
5. maintenance-Change is cemented into behavior Conflict Management & Group dynamics - Answer>> Interest- based conflicts Identity based conflicts Differences are the cause and the solution to the problem Conflict=NORMAL Unresolved conflict=Dysfunctional