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AANC Clinical Nurse Specialist (CNS) 2024 Exam Review Questions and Answers 100% Pass
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Conceptualization of CNS role - Answer>> domains of practice spheres of influence 1.Patient/client- Evidence based care incorporating best practice
develop plan of care evaluate outcomes Maslow Hierarchy of basic needs - Answer>> 1.BASIC: Food, shelter 2.SAFETY: security, door locks, lighting, employment resources
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
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
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.
-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
-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