4435: Final Exam, Acute Care A Section- Professional Identity, COVID-19, Other infections

Moral distress is described as: 1. One does not know what the moral decision in a clinical situation is. 2. One knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. 3. One has the power to do what is ethically correct in a situation, but chooses not to based on personal values.

2. The debilitating impact of moral distress on nurses is supported by research and includes burnout, disengagement from patients and families, stress-related illnesses, turnover, and leaving the profession.

The chief nursing officer (CNO) wishes to reduce nurse burnout, emotional exhaustion, and depersonalization among their nursing staff. With whom should the CNO collaborate to improve interprofessional collaboration and achieve this goal? A. Chief Medical Officer B. Director of Chaplaincy Services C. Chief Executive Officer D. Director of Respiratory Services

A. Chief medical officer -Nurses are more likely to report symptoms of burnout, emotional exhaustion, and or depersonalization from their relationships with physicians. -The CNO would therefore wish to collaborate with the Chief Medical Officer to implement measures to improve these relationships.

A public health nurse is teaching about risk of hantavirus transmission on a rural Native American reservation. Which of the following statements should the nurse include in the teaching? a. "There is a vaccine for hantavirus but it's not commonly given in the U.S." b. "Most people with hantavirus die from hemorrhaging of blood" c. "You should wear a face mask when cleaning your attic." d. "Hantavirus is not as common in New Mexico as it is in the Upper Plains states."

C Face masks should be worn when sweeping and cleaning poorly ventilated rooms, especially in rural areas Rodents shed hantavirus in their urine, droppings, and saliva The virus is mainly transmitted to people when they breathe in air contaminated with the virus. Hantavirus has no vaccine; the tuberculosis vaccine is used in other countries but is not commonly used in the U.S. Ebola's chief complication is hemorrhage West Nile Virus is more common in the Upper Plains and Rocky Mountain states but pockets of New Mexico have had cases as well

Fatality rate from COVID-19 is ____%

1-3% Severe illness is associated with male sex, elderly, obesity, CAD, HTN, DM, COPD. (Men more likely to suffer from severe disease than women, but no statistics on which sex gets infected more.)

T/F: It is possible that COVID-19 is less prevalent in children because of underdeveloped ACE 2 expression in kids, or because their inflammatory response is less than adults, or because there is a wide range of other viruses more common in kids that SARS-CoV-2 must compete with.

True

T/F: Pfizer and Moderna are mRNA vaccines approved for COVID-19. They require 2 initial doses.

True. Pfizer requires cold storage; Moderna does not require cold storage. Both are now approved for ages 6 months and up.

COVID-19 was first described in Wuhan, China, in December 2019. By January 2020, the viral cause was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initial cases were linked to Wuhan's Huanan seafood wholesale market. In epidemiological terms, this seafood market would be known as the _______. A. Susceptible host B. Reservoir C. Mode of Transmission D. Portal of Entry

Answer: B Reservoir

A patient with TB has been admitted to the hospital and is placed on airborne precautions and in an isolation room. What should the nurse teach the patient? (select all that apply) a. Expect routine TB testing to evaluate the infection. b. No visitors will be allowed while in airborne isolation. c. Adherence to precautions includes coughing into a paper tissue. d. Take all medications for full length of time to prevent multidrug-resistant TB. e. Wear a standard isolation mask if leaving the airborne infection isolation room.

Answer: c, d, e Rationale: To reduce antibiotic-resistant tuberculosis, patients must take multiple drugs for a minimum of 3 months. If patients need to be out of the negative-pressure room, they must wear a standard isolation mask to prevent exposure to others. Teach patients to cover the nose and mouth with paper tissue every time they cough, sneeze, or produce sputum. If a person has a positive reaction to the tuberculin skin test, he or she does not need to be tested again because the sensitivity to tuberculin persists throughout life. Nurses and visitors must wear high-efficiency particulate air (HEPA) masks when entering the patient's room

The chief nursing officer (CNO) has received a complaint from a staff nurse about futile treatment of a patient with COVID-19. How should the CNO address the complaint? a. Forward the complaint to the hospital's ethics committee b. Attend daily interprofessional rounds, along with the hospital chaplain, to advocate the nurse's concern c. Convene a debriefing once the patient has died to discuss areas for improvement in the future d. Inform the staff nurse they should consider transferring to a department with lower acuity patients

B. -One of the ways organizations can promote moral resiliency is by making certain that ethical concerns are part of the interprofessional team's daily discussion during patient rounds. -This can be facilitated by including a chaplain or some other arbiter in the discussion of patient care -Making the complaint someone else's problem or waiting until after the patient has died are not appropriate -Insisting that the nurse should work with lower acuity patients does not lead to developing moral resiliency

_____ has been noted to be elevated in COVID-19 patients during this acute pneumonia phase. A. Interleukin-3 B. Interleakin-6 C. Interleukin-11

B. IL-6 has unique role in the cytokine storm occurring in patients with COVID-19. Interleukin 6 (IL-6), promptly and transiently produced in response to infections and tissue injuries, contributes to host defense through the stimulation of acute phase responses, hematopoiesis, and immune reactions.

Which of the following is the most widely used instrument to measure burnout? A. Maslow's Hierarchy of Needs B. Primary Care Evaluation of Mental Disorders Patient Health C. Maslach Burnout Inventory D. Visual Analogue Scale

C. MBI The Maslach Burnout Inventory (MBI), is internationally the most widely used instrument to measure burnout. According to Maslach's conceptualisation, burnout is a response to excessive stress at work, which is characterized by feelings of being emotionally drained and lacking emotional resources—Emotional Exhaustion; by a negative and detached response to other people and loss of idealism—Depersonalisation; and by a decline in feelings of competence and performance at work—reduced Personal Accomplishment. Maslach theorized that burnout is a state in which there is a prolonged mismatch between a person and one of the following dimensions of work:workload, control, reward, community fairness, or values.

T/F The Omicron subvariant B.5, which has been the s=most prevalent strain of COVID-19 since early summer 2022, is much more dangerous and causes more severe illness than previous variants.

FALSE As of September, 2022 the omicron subvariant BA.5 has been the predominant strain since early summer, 2022. Alternately, the preceding variant Omicron and its subvariants have mutations that allow it to evade previous vaccines and boosters; infections continue to be milder and affect the upper airway as opposed to previous variants that have caused more severe illness and affects the lungs predominantly.

T/F: The Pfizer vaccinehas proven to have the greatest efficacy of all vaccines for COVID-19 over time

FALSE, Moderna has the greatest efficacy and sustainability over time, with less breakthrough infection as the Delta variant of the virus emerged.

In what ways does SARS-CoV-2 have negative endocrine effects on the body?

When the spike of the virus attaches to ACE2 receptors, excess Angiotensin 2 hormone floats around the body with nowhere to attach. This increases damage to endothelial blood cell linings, which thus increases blood pressure. ACE2 can also create alveolar cell death.

What are the three phases on COVID-19 infection: A. Primary phase, Secondary phase, Tertiary phase B. Viremia, Acute phase, Resolution or Inflmmatory phase C. Viremia, Inflammatory phase, Apoptosis phase

Answer: B Key features: 1) Early infection (viremia. 2) 7 to 14 days later, viral pneumonia (acute phase). Then either 3a) Suppression of the infection occurs in most people with well-functioning immune systems (resolution) OR 3b) Inflammatory phase occurs in some patients who are elderly or who have comorbidities. This inflammatory phase may consist of: Ø Lung damage Ø Clotting disorders Ø Exaggerated immune system response

NovoVax is a protein subunit vaccine approved for ages 12 and up. It requires 2 doses, with the second 3-8 weeks after the first. Boosters should happen at least 2 months after the second dose. This booster MUST be the ______: A. Moderna vaccine B. Pfizer vaccine C. NovoVax D. Johnson & Johnson

Answer: B. Pfizer

A client who has been infected with the Ebola virus has an emesis of 750 mL of bloody fluid and complains of headache, nausea, and severe lightheadedness. Which action included in the treatment protocol should the nurse take first? a. Give acetaminophen 650 mg PO b. Administer ondansetron 4 mg IV c. Infuse NS at 500 mL/hr d. Increase oxygen flow rate to 6 L/min

Answer: C. Patient can't take PO meds if vomiting, so not A. Ondansetron will prevent future occurrence of vomiting. NS at 500 will replace lost fluids now (abC). Increasing oxygen means that patient is already on O2, but the pt does not have a respiratory problem.

Droplets and aerosols from the SARS-CoVE-2 Virus can stay in the air for up to ____. A. 1 hour B. 10 hours C. 3 hours D. 30 minutes

Answer: C. 3 hours

SARS-CoV-2 binds to ACE2 receptors, creating a gatewa for the virus to enter a host cell. ACE2 receptors can be found in which human cells? A. Skeletal muscle cells B. Lungs only C. Lungs, kidney, brain, myocardial cells, GI tracr, blood vessels, and pancreas. D. Everywhere in the body

Answer: C. ACE2 are primarily found in the lungs, but can be found in these other areas as well.

Antigen tests for covid-19 are known to give false negative and false positive results, and should always be followed up by a _____ test

Answer: PCR (Polymerase Chain Reaction) PCR tests are a type of Molecular diagnostic test (e.g. reverse transcription polymerase chain reaction [PCR test]). At Point of care, they take about 15-45 minutes for results. From the lab they may take 1-3 days for results. These tests are usually more accurate, and are used for confirmation of positive antigen tests

A patient diagnosed with COVID-19 a week ago presents to the emergency department with a dry cough and intractable nausea. The patient admits to taking ivermectin which they purchased from a veterinary supply company. Which of the following would alert the nurse to further deterioration because of ingesting ivermectin? a. Vomiting b. Dysrhythmias c. Decreased level of consciousness d. Increased blood pressure

C. -Ivermectin is an anti-parasitic medication given to treat worms. Current evidence suggests this is not an effective treatment for COVID but clinical trials are underway. Side effects include: · Nausea and vomiting · Diarrhea · Hypotension · Allergic reactions (itching and hives) · Dizziness · Ataxia · Seizures · Coma · Death

A patient with suspected bacterial meningitis just had a lumbar puncture in which cerebrospinal fluid was obtained for culture. Which medication should the nurse give first? A. Codeine B. Phenytoin C. Ceftriaxone D. Acetaminophen

Correct Answer: Ceftriaxone Rationale: Bacterial meningitis is a medical emergency. When meningitis is suspected, antibiotic therapy (e.g., ceftriaxone) is started immediately after the collection of specimens for cultures and even before the diagnosis is confirmed. Dexamethasone may be given before or with the first dose of antibiotics. The nurse should collaborate with the health care provider to manage the headache (with codeine), fever (with acetaminophen), and seizures (with phenytoin).

The nurse assesses a patient for signs of meningeal irritation. Which finding indicates nuchal rigidity is present? a. Tonic spasms of the legs b. Curling in a fetal position c. Arching of the neck and back d. Resistance to flexion of the neck

Correct Answer: Resistance to flexion of the neck Rationale: Nuchal rigidity is a manifestation of meningitis. During assessment, the patient will resist passive flexion of the neck by the health care provider. Tonic spasms of the legs, curling in a fetal position, and arching of the neck and back are not related to meningeal irritation. (Brudzinski's sign is positive when passive forward flexion of the neck causes the patient to involuntarily raise his knees or hips in flexion.)

A nursing measure that can reduce the potential for seizures and increased intracranial pressure in the patient with bacterial meningitis is a. administering codeine for relief of head and neck pain. b. controlling fever with prescribed drugs and cooling techniques. c. maintaining strict bed rest with the head of the bed slightly elevated. d. keeping the room dark and quiet to minimize environmental stimulation.

Correct answer: b Rationale: Fever must be vigorously managed because it increases cerebral edema and the frequency of seizures. Neurologic damage may result from an extremely high temperature over a prolonged period. Acetaminophen or aspirin may be used to reduce fever; other measures, such as a cooling blanket or tepid sponge baths with water, may be effective in lowering the temperature.

The nurse on the clinical unit is assigned to four patients. Which patient should she assess first? a. Patient with a skull fracture whose nose is bleeding b. An older patient with a stroke who is confused and whose daughter is present c. Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0- to 10 scale d. Patient 2 days postoperative after a craniotomy for a brain tumor who has had continued vomiting

Correct answer: c Rationale: The patient with meningitis should be seen first. Patients with meningitis must be observed closely for manifestations of increased ICP, which is thought to result from swelling around the dura and increased cerebrospinal fluid (CSF) volume. Sudden change in the level of consciousness or change in behavior along with a sudden severe headache may indicate an acute elevation of ICP. The patient who has undergone cranial surgery should be seen second. Although nausea and vomiting are common after cranial surgery, it can result in elevations of ICP. Nausea and vomiting should be treated with antiemetics. The patient with a skull fracture needs to be evaluated for CSF leakage occurring with the nosebleed and should be seen third. Confusion after a stroke may be expected; the patient should have a family member present.

T/F: Hydroxycloroquine and Ivermectin have been statistically proven to lessen the disease process caused by the SARS-CoV-2 virus.

FALSE · Hydroxycloriquine: antimalarial for lupus. No longer recommended by FDA bc of cardiac arrest and other cardiac side effects. Causes QT segment elongation. · Ivermectin: antiparasitic for worms in livestock. Not effective for covid, clinical trials underway. Many Sd fx: N/V/D, hypotension, dizziness, ataxia, seizure, coma, death Proven effectiveness: · D: keeps cell junctions tighter, maybe keeps virus from hijacking cells? · Dexamethasone: tamps exaggerated immune system response, only for those with SEVERE disease · Remdesivir: originally for ebola (didn't work); improves recovery time but doesn't improve mortality · MABs: bind to spike and prevents virus from entering host cells. For people with MILD disease to prevent worsening symtpoms, should be started as soon as symptoms start. Expensive · Paxlovid: PO antiviral Pfizer. Nirmatrelvir slows rna replications. Ritonavir was for HIV, it slows down breakdown of nirmatrelvir. Shows 80% efficacy. · Molnupiravir: PO antiviral Merk. Slows viral replication. Studies initially positive, but with time perhaps less efficacy (30%)

COVID-19 symptoms and relative frequency:

Fever 83%-99% Cough 59%-82% Fatigue 44%-70% Anorexia 40%-84% Shortness of breath 31%-40% Sputum production 28%-33% Myalgias 11%-35%

The COVID-19 Johnson & Johnson vaccine is approved for ages 18 and up. It consists of coronavirus integrated with adenovirus. It currently has the _____(least/most) efficacy of the vaccines approved in the USA.

LEAST, at 65-80%

T/F: COVID-19 patients may also develop sepsis, myositis, shock, cardiomyopathy, thromboembolic disease, and multiple-organ dysfunction.

TRUE Excessive host immune responses can cause a "cytokine storm" and cause multiple manifestations, including neurological line acute necrotizing encephalopathy and Guillain-Barre syndrome.

A nurse is caring for a 4 year old patient with suspected bacterial meningitis. With the patient laying down, the nurse lifts the head upward tilting the chin toward the torso. At the same time, the patient flexes their hips and knees. The nurse documents this finding as a positive: a. Brudzinski's sign b. Kernig's sign c. Grey-Turner's sign d. Levine's sign

a. -Brudzinski's sign is positive when passive forward flexion of the neck causes the patient to involuntarily raise his knees or hips in flexion. -Kernig's is performed by having the supine patient, with hips and knees flexed, extend the leg passively. The test is positive if the leg extension causes pain. -Grey-Turner's sign is bruising to the flank, as sometimes seen in abdominal aortic aneurysms -Levine's sign is pressing the fist to the chest during a bout of angina

A nursing student is preparing to enter the hospital room of a patient diagnosed with COVID-19. Which of the following will the student need to don before entering? Select all that apply: a. Clean gown b. Nitrile gloves c. Goggles d. N-95 mask e. Surgical mask

all but E Per the CDC, staff entering rooms of patients with COVID-19 must follow enhanced contact/airborne precautions, including wearing: · Clean gown · Nitrile gloves · Goggles · N-95 mask A surgical mask would be appropriate for droplet precautions, but not airborne precautions

A nurse is educating a parent of a 10 year-old patient on approved COVID-19 vaccines. Which statement made by the parent reflects correct learning on this topic? a. "The Johnson & Johnson vaccine had the highest levels of efficacy in clinical trials." b. "The Novavax vaccine only requires one inoculation." c. "The Astra-Zeneca vaccine is the most widely available vaccine in the United States." d. " I should get the Pfizer vaccine today and return in three weeks for the second shot."

d. -As of Fall, 2022: · The Pfizer and Moderna vaccines are the only ones approved for ages 6 months and up. It requires two inoculations three weeks apart (Pfizer) and four weeks apart (Moderna). · Novavax is only approved for ages 12 and up and requires 2 inoculations · Johnson & Johnson had efficacy levels between 65-80% in clinical trials; the mRNA vaccines had higher efficacy · The Astra-Zeneca vaccine is not approved for use in the United States

A critical care nurse is caring for a patient who was intubated 2 weeks ago for respiratory failure related to advanced lung cancer. The patient's spouse wishes for treatment to continue in spite of the patient's grim diagnosis. The nurse feels this plan prolongs the patient's suffering. To preserve moral resiliency, the nurse should: a. File a complaint to the hospital's ethics committee b. Refuse to care for this patient c. Inform the spouse that her wishes are morally objectionable d. Find meaning in the challenging situation to resolve cognitive dissonance

d. -One of the most important tools in preserving moral resiliency is to find meaning in situations that challenge one's sense of morals. -This doesn't ignore the moral conflict but helps to look at it in a more nuanced way.