Amercian Sentinel N521 2021 May Complete Course Latest

N521 Advanced Pharmacology

Module 1 Discussion

Locate your state’s nurse practice act (NPA) and associated regulations governing prescribing by advanced practice nurses (CNPs, CRNAs, CNMs, CNSs). Answer and discuss the following in this forum:

Does your NPA require the APRN to have a collaborative agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a collaborative agreement, and explain why/why not.

Does your NPA require the APRN to have a prescribing agreement with a physician? Discuss whether you think the NPA should or should not require the APRN to have a prescribing agreement, and explain why/why not.

Does your NPA permit APRNs to prescribe all classes (schedules) of medications? Discuss whether you think the NPA should or should not permit APRNs to prescribe all classes of medications, and explain why/why not.

Describe collaborative approaches to treating rashes across the lifespan. Should the CNP treat without a collaborator or consultant? Support your statements based upon evidence.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Module 2 Discussion

A.C. is a 60-year-old Caucasian woman with newly diagnosed peptic ulcer disease, generalized anxiety disorder, and iron deficiency anemia. She also has a long history of asthma and depression. She is a strong believer of herbal medicine. She takes St. John’s wort for her depression, iron pills for her anemia, and alprazolam (Xanax) as needed for her anxiety. During her asthma exacerbation, she is instructed to take prednisone for at least 5 days. She also takes esomeprazole (Nexium) for her peptic ulcer disease. Three months later, she experienced severe fatigue, shortness of breath, dizziness, and swelling/soreness in the tongue. Her asthma is well controlled with the occasional use of albuterol (Proventil) inhaler. During her physical exam, her physician suspected that she had bacterial vaginosis and gave her a prescription for a 1-week course of metronidazole (Flagyl). She drinks at least two to three cans of beer per day.

Review the above case and post a discussion that evaluates the potential for interactions that may increase drug availability.  What is the cause of increased drug availability?  Evaluate for interactions that will decrease drug availability.  What is the cause of decreased drug availability?  What recommendations may be made concerning the co-administration of these medications?

Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Module 3 Discussion

M. L. is a 15-year-old Hispanic female who plays soccer for her school team. She has noticed that when running, she sometimes has trouble catching her breath. She also reports an increased runny nose and itchy eyes. She has a frequent dry cough and is awakened with coughing spells at least four times a week. Her mother and father have seasonal allergies and her mother has asthma. This morning she woke up and heard “funny sounds” when she took a breath. Her coughing increased when she took a deep breath. In her nose, the mucosa is pale and swollen bilaterally. Her lungs have bilateral expiratory wheezing; respirations are 22 and PEF is 400. Her heart shows a normal sinus rhythm, with no murmurs or gallops; pulse is 72; and there is no cyanosis.        

Diagnosis: Mild Persistent Asthma

In this discussion forum: 

Discuss specific goals of pharmacotherapy for treating M. L.’s mild persistent asthma.

Discuss the drug therapy a CNP would likely prescribe and why.

Discuss the parameters for monitoring the success of the therapy.

Discuss age appropriate health promotion recommendations you would consider for M. L.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Module 4 Discussion

R. S., a 65-year-old African-American man, was referred to the CNP in the hypertension clinic for evaluation of high BP noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year. Past medical history: Appendectomy 30 years ago, Peptic ulcer disease 10 years ago, Type 2 diabetes mellitus for 10 years; Family history: Father had hypertension; died of myocardial infarction at age 55, Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60; Physical examination: Height 69 in, weight 108 kg; BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm); Pulse: 84 beats/min, regular; Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages; Laboratory findings: Blood urea nitrogen: 24 mg/dL, Serum creatinine: 1.5 mg/dL, Glucose: 95 mg/dL, Potassium: 4.0 mEq/L, Total cholesterol: 201 mg/dL, High-density lipoprotein cholesterol: 30 mg/dL, Triglycerides: 167 mg/dL, Urinalysis: 1+ proteinuria; Electrocardiogram and chest radiograph: mild left ventricular hypertrophy; Social history: Tobacco: 35 pack years, Alcohol: pint of vodka/week, Coffee: 2 cups/day

Diagnosis: Stage 1 Hypertension

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol

Discuss what you would consider to be first-line pharmacotherapy for R. S., and why.

Discuss the parameters for monitoring the success of the therapy.

Discuss health promotion recommendations you would consider for R. S.

Does the presence of Diabetes Mellitus impact your treatment selection?

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

 

N521 Advanced Pharmacology

Module 5 Discussion

This week if your last name begins with A-L complete case 1 and reply to two peers in case 2.  If your last name begins with M-Z complete case 2 and reply to two peers in case 1.

Case 1:

C. J. is a 55-year-old Hmong postmenopausal woman presenting with Type II diabetes mellitus, hypertension and urinary incontinence. She reports that she often cannot get to the bathroom in time when she feels the urge to urinate. She also wets herself when she laughs or sneezes. She is very embarrassed about this problem and has decreased her excursions from the house because of it. She drinks six cups of coffee a day. She does not follow a special diet, She takes hydrochlorothiazide for hypertension, and metformin for DM. Today her HgbA1C is 12.  She wants treatment for her urinary complaints.

Diagnosis: Uncontrolled Type II DM, HTN, and urinary incontinence

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating C. J..

Discuss the drug therapy a CNP would likely prescribe and why.    

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for C. J.

Case 2:

Mr. Z is a 36-year-old construction worker who presents to the nurse with fatigue and a foot ulcer. He is a smoker with type 1 diabetes for 25 years, and he take 20 units of

70/30 insulin twice a day. He lost his meter a year ago. He is very thin, although he eats constantly on the job because he is worried about hypoglycemia; he cannot remember the last time he had hypoglycemia, but it was years ago.  He recently received a call from the office because his TSH level was greater than 10 and he was told he has “thyroid” problems.  He thinks this may be the cause of his fatigue.

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating Mr Z

Discuss the drug therapy a CNP would likely prescribe and why.    

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for Mr Z.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

 

 

N521 Advanced Pharmacology

Module 6 Discussion

J. P. is a 36-year-old Caucasian gay male who was diagnosed with HIV infection 2 years ago. He and his male partner, T. R., were married shortly after his diagnosis. T. R. is not HIV positive. He has been feeling well for the past 2 years, and he maintains a healthy, active lifestyle by exercising three to four times a week and eating a balanced diet. His medications include a multiple vitamin and occasional omeprazole for heartburn. He has never received antiretroviral therapy. He comes to your office for a routine physical exam and blood work. The physical examination is unremarkable, and the laboratory results are as follows: Electrolytes, serum creatinine, liver function tests: within normal limits; Complete blood count with differential: within normal limits, CD4+ T-cell count: 210 cells/mm3; Viral load: 10,000 copies/mL, Genotype: No resistance mutations detected                            

Diagnosis: Asymptomatic HIV Infection

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. P.’s asymptomatic HIV infection.

Discuss when prophylaxis for infection is indicated ie daily bactrim

Discuss the drug therapy a CNP would likely prescribe and why.

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for J. P.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Module 7 Discussion

J. T., who is a Native American male, age 8, is always interrupting his teacher, jumping out of his seat in class, fidgeting relentlessly, and butting into other children’s games. At home, he runs around recklessly and is uncontrollable. His mother comes to the CNP in the Pediatric Clinic and wonders why he will not listen. She is concerned because his grades at school are dropping. After medical evaluation, you find nothing wrong with J. T. physically, and he is taking no other medications. Through questioning, you determine that he has trouble concentrating on his homework, often forgets he has homework, loses pieces of games frequently, and hates to sit and read. His mother is unsure of the time frame over which these behaviors developed, but she thinks it has been since her second child was born 5 years ago. While in your office, J. T. did not seem to be hyperactive or inattentive, but you notice he is easily distracted by people passing in the hallway because the door is slightly ajar.  

Diagnosis: Attention-Deficit Hyperactive Disorder (ADHD)

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. T.’s ADHD.

Discuss the first-line drug therapy for J. T., and why.

Discuss monitoring parameters you would institute for J. T.’s parents and his teachers.

Discuss specific patient education you would provide to J. T.’s parents based on the prescribed therapy.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Module 8 Discussion

J. L., a 27-year-old African-American female account executive, presents to the Family Medicine office for her annual checkup with her CNP. She has no significant past medical history. Her medications include calcium carbonate 500 mg orally twice a day and a multivitamin daily. She exercises regularly. Her family history is significant for cardiovascular disease (her father had an MI at age 54 and died of a further MI at age 63). She notes that she has been dating her current partner for approximately 5 months. She is interested in a reliable form of contraception. After discussing the various contraceptive options, she decides that an oral contraceptive (OC) would best fit her needs.

In this discussion forum:                                

Discuss what tests or examinations the CNP would likely perform before prescribing an OC regimen, and why.

Discuss two different OC regimens that could be chosen for J. L. Discuss their differences and why you chose them.

Discuss the potential side effects of each OC regimen that need to be relayed to J. L. Discuss especially those effects for which she should seek immediate medical care.

Discuss health promotion recommendations you would consider for J. L.

What ethical issues should be considered?

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.

 

N521 Advanced Pharmacology

Assignment 1

Using peer-reviewed journal articles or evidence-based practice websites locate policy or regulatory position statements or campaigns that support changes in APRN prescribing practices at the state or national level.

In a paper not to exceed six double-spaced pages, excluding title and reference pages, analyze these statements by assessing their alignment with the American Association of Nurse Practitioners (AANP)’s Nurse Practitioner Prescriptive Privilege statement (see AANP Position Statement & Papers). Use the Assignment 1 Rubric below to guide you in completing this assignment.

 

 

 

 

N521 Advanced Pharmacology

Assignment 2

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to his CNP in his family practice clinic. He presents with progressive difficulty getting his breath while doing simple tasks. He is having difficulty doing any manual work, but he has no symptoms when working behind his desk. He also reports a cough, fatigue, and weight loss. He has been treated for three respiratory infections a year for the past 3 years and feels like another one is developing now. On physical examination, you notice clubbing of his fingers, use of accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs. Pulmonary function studies show an FEV1 of 58%.

In a paper not to exceed six pages, excluding title and reference pages, please answer the following:

What is R. W.’s likely diagnosis?

What stage of disease does RW have?

List specific pharmacotherapeutic treatment goals for R. W.

What drug therapy would the CNP likely prescribe? Why?               

What are the parameters for monitoring the success of the therapy?

Describe specific patient education based on the prescribed therapy.

List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.

What would be the choice for second-line therapy?

What health promotion activities should be recommended for this patient?

If RW was currently taking metoprolol for “headaches” would a change be recommended?

Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work.

 

N521 Advanced Pharmacology

Assignment 3

L. P., age 23, is a Hispanic woman who graduated from college last year. She reports to the CNP in her local community mental health center. She began working as an accountant 1 month after graduating. Approximately 2 months ago, she moved into a two-bedroom apartment with another woman who works at the same accounting firm. She states that her roommate recommended that she see a doctor to find out if she has anemia or “some sort of fatigue syndrome.” She states that she has felt “restless” and “on edge” for most of the past 9 months. She becomes easily fatigued and irritable and has difficulty concentrating and falling asleep. She states that sometimes her mind “just goes blank,” and she is worried that her work performance is no longer excellent. She reports that all her life she had good grades in school and was very successful in everything she attempted. Although she has been “a worrier from the day I was born,” now she worries more than she ever has and feels nervous “all the time.” L. P. reports that she has a good relationship with her boyfriend but they do not get to see each other very often because he is attending graduate school 100 miles away. She reports having a satisfying sexual relationship with him. She denies having any problems with relationships with her parents, roommate, or peers. She denies having any financial worries unless she is fired from her job for poor work performance. She reports that she has always been healthy and has taken good care of herself. The only medication she takes is birth control pills, which she has taken for the past 4 years without any adverse effects.

In a paper not to exceed six pages, excluding title and reference pages, submit your answers to the following in an MS Word document:

What is L. P.’s likely diagnosis?

List specific pharmacotherapeutic treatment goals for L. P.

Should the CNP order any labs for L. P. at this time? Why?

What drug therapy would the CNP likely prescribe? Why?

What are the parameters for monitoring the success of the therapy?

Describe specific patient monitoring based on the prescribed therapy.

List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.

L. P. returns to see the CNP after six weeks, complaining of still feeling anxious and had heard of a medication called Klonopin that she would like to try; how should the CNP respond to her request?

What health promotion activities should be recommended for this patient?

What is L. P.’s long-term prognosis?

Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work.

 

Progress Test 1

Question 1The CNP orders the patient a tetracycline antibiotic and instructs him to avoid taking the medication with foods, beverages, or drugs that contain calcium, iron, or magnesium. The patient takes the antibiotic along with a daily multivitamin, not realizing that the vitamin contains iron. What effect may this have on the tetracycline?

Select one:

a.Decreased metabolism

b.Impaired excretion

c.Impaired absorption

d.Increased distribution

Question 2During completion of the exam and review of the patient’s most recent medical record notes, it is noted by the CNP that the patient has a malignant brain tumor. What pharmacokinetic phase may be affected by the presence of the tumor?

Select one:

a.Absorption

b.Metabolism

c.Excretion

d.Distribution

Question 3The patient requires a drug to be prescribed by the CNP that is known to be completely metabolized by the first-pass effect. During the prescribing process the CNP knows that due to this requirement:

Select one:

a.The drug must be given in a lipid-soluble form.

b.The drug must be given in higher doses.

c.The drug must be given by a non-oral route.

d.The drug must be given more frequently.

Question 4A patient with cirrhosis of the liver exhibits decreased metabolic activity. This will require the CNP to make what possible changes in the patient’s pharmacotherapeutic regimen? (Select all that apply.)

Select one or more:

a.A change in the timing of medication administration

b.Giving all prescribed drugs by intramuscular injection

c.More frequent monitoring for adverse drug effects

d.An increased dose of prescribed drugs

e.A reduction in the dosage of the drugs

Question 5A patient who is in renal failure may have a diminished capacity to excrete medications. During the course of drug therapy, the CNP must assess the patient more frequently for what development?

Select one:

a.Increased risk of allergy

b.Increased absorption of the drug from the intestines

c.Increased risk for drug toxicity

d.Decreased therapeutic drug effects

 

 

Progress Test 2

Question 1A 16-year-old adolescent is 6 weeks pregnant. The pregnancy has exacerbated her acne. She asks her CNM if she can resume taking her isotretinoin (Accutane) prescription, a category X drug, prescribed by her dermatologist. What is the most appropriate response by the CNM:

Select one:

a.“You should reduce the Accutane dosage by half during pregnancy.”

b.“Accutane is known to cause birth defects and should never be taken during pregnancy.”

c.“Since you have a prescription for Accutane, it is safe to resume using it.”

d.“You should consult with your dermatology provider at your next visit.”

Question 2To reduce the effect of a prescribed medication on the infant of a breastfeeding mother, how should the CNM teach the mother to take the medication?

Select one:

a.Immediately before the next feeding

b.At night

c.In divided doses at regular intervals around the clock

d.Immediately after breastfeeding

Question 3To reduce the chance of a duplicate medication order for the older patient who presents for his first outpatient visit with a CNP after a hospitalization, what action should the provider take? (Select all that apply.)

Select one or more:

a.Call in all prescriptions to the patient’s pharmacies rather than relying on paper copies of prescriptions.

b.Give all prescriptions to the patient’s family member.

c.Take a medication history, including all OTC and prescription medications and a pharmacy history.

d.Work with the patient’s other health care providers to limit the number of prescriptions.

e.Perform the process of medication reconciliation before sending the patient home.

Question 4Little human research has explored the safety or harmfulness of herbs in:

Select one:

a.pregnancy

b.lactation

c.Both a and b

d.Neither a nor b

Question 5According to a survey conducted by AARP and the NCCAM in 2006:

Select one:

a.50% of people 50 years of age or older do not talk to their doctors about their use of CAM.

b.69% of people 50 years of age or older do not talk to their doctors about their use of CAM.

c.25% of people 50 years of age or older do not talk to their doctors about their use of CAM.

d.10% of people 50 years of age or older do not talk to their doctors about their use of CAM.

 

 

Progress Test 3

Question 1A patient is prescribed NPH and regular insulin every morning by his CNP, who is verifying that the patient understands that there are two different peak times to be aware of for this insulin regimen. Why is this important for the provider to address?

Select one:

a.The risk for hypoglycemia is greatest around the peak of insulin activity.

b.It is best to plan exercise or other activities around peak insulin activity.

c.The client needs to plan the next insulin injection around the peak times.

d.Additional insulin may be needed at peak times to avoid hyperglycemia.

Question 2The CNP prescribes 5 units of Humalog and 25 units of NPH (Isophane) insulin prior to breakfast. The provider should tell the patient which of the following:

Select one:

a.Consume a high-carbohydrate snack in 6 hours.

b.Make sure your breakfast is available to eat before administering this insulin.

c.Administer the medications in two separate syringes.

d.Hold the insulin if your blood glucose level is greater than 100 mg/dL.

Question 3A 63- year-old client with type 2 diabetes is admitted with an infected foot ulcer. Despite previous good control on glyburide (Micronase), his blood glucose has been elevated the past several days and he now requires sliding-scale insulin. The CNP explains to the patient’s primary nurse that the most likely reason for the elevated glucose levels is:

Select one:

a.patients with diabetes who are admitted to the hospital are switched to insulin for safety and tighter control.

b.a temporary condition related to the stress response with increased glucose release.

c.the oral antidiabetic drug is no longer working for him.

d.the patient is converting to a type 1 diabetic.

Question 4Multiple studies, such as the Diabetes Mellitus Control and Complications Trial research group (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), continue to show that intensive glucose control may prevent and/or delay the onset of complications:

Select one:

a.at or below glycosylated hemoglobin (A1c) of 7%.

b.at or below glycosylated hemoglobin (A1c) of 12%.

c.at or below glycosylated hemoglobin (A1c) of 10%.

d.at or below glycosylated hemoglobin (A1c) of 15%.

Question 5Onset of type 1 diabetes may occur:

Select one:

a.suddenly as with the onset of diabetic ketoacidosis.

b.slowly with less risk of ketoacidosis as in the case of latent autoimmune diabetes of adults (LADA).

c.Both a and b

d.Neither a nor b

 

 

Progress Test 4

Question 1The Infectious Diseases Society of America released new guidelines advising providers against routine antibiotic treatment of sinusitis, because most cases are caused by viruses. When antibiotics are used, the guidelines suggest:

Select one:

a.amoxicillin alone.

b.amoxicillin-clavulanate instead of amoxicillin alone.

c.amoxicillin for one week followed by amoxicillin-clavulanate for one week

d.Either b or c.

Question 2Among the statements below, select the one which provides the best rationale for treatment with group A β-hemolytic streptococci:

Select one:

a.It is extremely easy to accurately diagnose a bacterial pharyngitis by history and physical alone. A throat culture is not necessary before treatment with group A β-hemolytic streptococci.

b.It is extremely difficult to accurately diagnose a bacterial pharyngitis by history and physical alone. A throat culture is optional but highly recommended before treatment with group A β-hemolytic streptococci.  

c.It is extremely easy to accurately diagnose a bacterial pharyngitis by history and physical alone. A throat culture is optional before treatment with group A β-hemolytic streptococci.

d.It is extremely difficult to accurately diagnose a bacterial pharyngitis by history and physical alone. A throat culture is necessary before treatment with group A β-hemolytic streptococci.

Question 3 C. difficile is often associated with copious liquid diarrhea and is a consequence of treatment with all antibiotics. Among the following which are most likely to cause C. difficile infection: 

Select one:

a.ampicillin

b.amoxicillin

c.cephalosporin

d.All of the above

Question 4Nonpharmacologic interventions for an uncomplicated UTI may include rest, hydration to flush the urinary tract, and short-term use of urinary analgesics with agents such as:

Select one:

 

a.Phenazopyridine

b.Urised

c.Both a and b

d.Neither a nor b

Question 5For patients with uncomplicated genital, rectal, and pharyngeal gonorrhea, the CDC recommendations call for combination therapy using:

Select one:

a.ceftriaxone 100 mg as a single IM dose, plus azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days.

b.ceftriaxone 250 mg as a single IM dose, plus either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days.

c.ceftriaxone 250 mg as a single IM dose, plus azithromycin 1 g orally in a single dose or doxycycline 200 mg orally twice daily for 7 days.

d.ceftriaxone 50 mg as a single IM dose, plus azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days.