Nursing

Assignment: prescribed oprelvekin therapy
Assignment: prescribed oprelvekin therapy
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Question 17 A female patient is prescribed oprelvekin therapy to treat thrombocytopenia. Which of the following should the nurse continuously monitor to determine the efficacy and duration of the oprelvekin therapy?
A) Weight gain
B) Platelet count
C) Red and white blood cell count
D) Cardiac arrhythmias
Question 18 During ongoing assessment of a patient receiving 5-FU therapy, the nurse finds the patient’s platelet count to be 92,000 cells/mm3. The nurse should do which of the following?
A) Consult the prescriber for an increase in dosage
B) Consult the prescriber for a decrease in dosage
C) Consult the prescriber for discontinuation of the drug
D) Continue the therapy as prescribed
Question 19 A nurse has been assigned to a female patient who is to begin chemotherapy. The nurse will initiate the prescribed oprelvekin therapy
A) 6 to 24 hours after chemotherapy.
B) 2 days after chemotherapy.
C) 6 days after chemotherapy.
D) 10 days after chemotherapy.
Question 20 A patient with a recent diagnosis of chronic myelogenous leukemia (CML) is discussing treatment options with his care team.What aspect of the patient’s condition would contraindicate the use of cyclophosphamide for the treatment of leukemia?
A) The patient has a diagnosis of type 2 diabetes and takes oral antihyperglycemics.
B) The patient has had a history of nonadherence to medical treatment.
C) The patient’s bone marrow function is significantly depressed.
D) The patient has decreased renal function.
Question 21 A female patient has follicular non-Hodgkin’s lymphoma and is receiving thalidomide (Thalomid). It will be most important for the nurse to monitor this patient for which of the following?
A) Angina
B) Fever
C) Chills and rigors
D) Bleeding
Question 22 When planning care for a patient who is receiving filgrastim (Neupogen) for a nonmyeloid malignancy, the nurse should formulate which of the following patient outcomes? (Select all that apply.)
A) The patient will not develop an infection.
B) The patient will not experience bone pain.
C) The patient will be able to self-administer filgrastim at home.
D) The patient will not develop febrile neutropenia.
E) The patient will not retain fluid.

Discussion: Functions of consciousness
Discussion: Functions of consciousness
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After viewing the program and completing the reading assignment, you should be able to:
1. Describe the functions of consciousness.
2. Describe the different levels of consciousness and the kinds of processing that occur at each level.
3. Define circadian rhythms and describe their relation to the 24-hour day cycle.
4. Describe the stages of sleep.
5. Identify the major sleep disorders and the effects of sleep deprivation.
6. Discuss the difference between night dreaming and day dreaming, and describe lucid dreaming.
7. Explain Freud’s theory of dreaming and contrast it with the Hobson-McCarley theory and the information-processing theory.
8. Give examples of the difference between a dream’s manifest content and latent content.
9. Describe the issues concerning sleep that will arise as people’s lives become more driven and as world travel becomes easier.
Objectives 14
After viewing the program and completing the reading assignment, you should be able to:
1. Describe hypnotic techniques, experiences, and applications.
2. Explain the difference between psychological dependence and physical addiction.
3. Define the major drug categories, and compare the effects of specific drugs, such as stimulants and depressants.
4. List and describe the characteristics of the various extended states of consciousness, such as lucid dreaming, hypnosis, mediation, hallucinations, and drug use.
5. Describe the three levels of consciousness.
6. Explain the phenomenon of “discovered memory.”
Objectives 15
After viewing the program and completing the reading assignment, you should be able to:
1. Define personality.
2. Compare type and traits theories of personality.
3. List and describe “The Big Five” dimensions of personality.
4. Describe Freud’s theory of personality development and the role of the id, ego, and superego in the conscious self.
5. Describe how post-Freudian theories differ from Freudian theories.
6. Describe the major humanistic theories and their contribution.
7. Describe social learning and cognitive theories and their contribution.
8. List the five most important differences in assumptions about personality across theoretical perspectives.
9. Compare the value and accuracy of standardized and projective tests of personality.

Case Study: Cardiorespiratory
Case Study: Cardiorespiratory
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Evaluate the Health History and Medical Information for Mrs. J., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Subjective Data
1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 850 words, critically evaluate Mrs. J.’s situation. Include the following:
1. Describe the clinical manifestations present in Mrs. J.
2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.
You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, and abstract is required.

Discussion: Diagnosis of Neurologic Disorders
Discussion: Diagnosis of Neurologic Disorders
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Musculoskeletal and neurologic disorders can present complications for pediatric patients from infancy to adolescence. These disorders affect patients physically and emotionally and often impact a patient’s ability to participate in or carry out everyday activities. Patients with these disorders frequently need long-term treatment and care requiring extensive patient management and education plans. Musculoskeletal and neurologic disorders present various symptoms because they affect multiple parts of a patient’s body. Consider treatment, management, and education plans for the patients in the following three case studies.
Case Study 1:
Clay is a 7-year-old male who presents in your office with complaints of right thigh pain and a limp. The pain began approximately 1 week ago and has progressively worsened. There is no history of trauma. Physical examination is negative except for pain with flexion and internal rotation of the right hip and limited abduction of the right hip. Limb lengths are equal.
Case Study 2:
Trevon is an 18-month-old with a 3-day history of upper-respiratory-type symptoms that have progressively worsened over the last 8 hours. His immunizations are up to date. Mom states he spiked a fever to 103.2°F this morning and he has become increasingly fussy. He vomited after drinking a cup of juice this afternoon and has refused PO fluids since then. Pertinent physical exam findings include negative abdominal exam, marked irritability with inconsolable crying, and he cries louder with pupil examination and fights head and neck assessment. You are unable to elicit Kernig’s or Brudzinski’s signs due to patient noncompliance.
Case Study 3:
Molly is a 12-year-old who comes to your office after hitting her head on the ground during a soccer game. Her mother reports that she did not lose consciousness, but that she seems “loopy” and doesn’t remember what happened immediately following her fall. She was injured when she collided with another player and fell backward, striking her head on the ground. She has no vomiting and denies diplopia but complains of significant headache. Physical examination is negative except for the presence of slight nystagmus. All other neurologic findings including fundoscopic examination are normal.
To prepare:
Review “Neurologic Disorders” and “Musculoskeletal Disorders” in the Burns et al. text.
Review and select one of the three provided case studies. Analyze the patient information.
Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
Consider strategies for educating patients and families on the treatment and management of the musculoskeletal or neurologic disorder.
By Day 3
Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the musculoskeletal or neurologic disorder.

Assignment: Medical Coding Discussion
Assignment: Medical Coding Discussion
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Assign CPT code(s) and appropriate modifiers to each statement.
1) After performing an emergency cesarean section, the physician noticed that the appendix was distended, resulting in medical necessity for an appendectomy performed during the same operative session.
2) The physician freed intestinal adhesions.
3) The physician resected two segments of small intestine and performed an anastomosis between the remaining intestinal ends. An open approach was used for this surgery.
4) The physician repaired a defect in the mesentery with sutures.
5) The physician performed a laparoscopic partial colectomy with end colostomy and closure of the distal segment.
6) The physician drained a pelvic abscess through the rectum.
7) The physician removed a portion of the rectum through combined abdominal and transsacral approaches.
8) The physician performed rigid proctosigmoidoscopy and obtained brushings.
9) The physician performed a flexible sigmoidoscopy and removed a polyp. The physician inserted the sigmoidoscope through the anus and advanced the scope into the sigmoid colon. The lumen of the sigmoid colon and rectum were well visualized, and the polyp was identified and removed with hot biopsy forceps. The sigmoidoscope was withdrawn upon completion of the procedure.
10) The physician inserted a colonscope through the anus and advanced the scope past the splenic flexure. Two polps were identified and removed by hot biopsy forceps.
1) Hepatotomy for open drainage of abscess or cyst, 1 stage.
2) Surgeon removed segments II, III, and IV (the whole left lobe) of the liver from a living donor.
3) The physician performed radiofrequency ablation of a liver tumor via open laparotomy.
4) The physician removed the gallbladder and performed a common bile duct exploration through the laparoscope.
5) The physician performed a cholecystostomy with removal of calculus.
6) Subsequent to previous peritoneocentesis (performed at a different operative session), the physician withdrew fluid and performed infusion and drainage of fluid from the abdominal cavity (peritoneal lavage).
7) The physician reopened a recent laparotomy incision, before the incision had fully healed, to drain a postoperative infection.
8) The physician performed laparoscopic repair of an initial inguinal hernia.
9) The physician performed a reducible ventral hernia (initial) repair and inserted mesh implantation.
10) The physician repaired an initial reducible, inguinal hernia with hydrocelectomy in a 5 month old infant.
1) Physician made an open incision and inserted multiple drain tubes to drain an infection (abscess) from the kidney.
2) The physician pulverized a kidney stone (renal calculus) by directing shock waves through a water cushion that was placed against the left side of the patient’s body at the location of the kidney stone.
3) The physician removed a kidney stone (calculus) by making an incision in the right kidney.
4) The interventional radiologist inserted a percutaneous nephrostomy catheter into the right renal pelvis for drainage. Fluoroscopic guidance was provided.
5) The physician performed a laparoscopic ablation of a solid mass from the posterior hilum of the left kidney.
6) The physician made an incision in the left ureter through the abdominal wall for examination of the ureter and insertion of a catheter for drainage.
7) The physician examined the patient’s right and left renal and ureteral structures with an endoscope, which passed through an established opening between the skin and the ureter (ureterostomy). He also inserted a catheter into the ureter.
8) The physician revised a surgical opening between the skin and the right ureter.
9) The physician injected contrast agent through an opening between the skin and the left ureter (ureterostomy) for ureterography (study of renal collecting system).
10) The physician made an incision in the left ureter (ureterotomy) to insert a catheter (stent) into the ureter.
11) The physician performed a transurethral resection of a postoperative bladder neck contracture using a resectoscope.
12) The physician inserted a special instrument through the cystourethroscope to fragment a calculus in the ureter using electrohydraulics.
13) The physician inserted a cystourethroscope through the urethra to drain an abscess on the prostate.
14) The physician made an incision through the abdominal wall into the urinary bladder and inserted a suprapubic catheter to withdraw urine.
15) The physician performed a cystourethroscopy with fulguration of the bladder neck and then removed a calculus from the ureter.
16) The physician performed a sling procedure using synthetic material to treat a male patient’s urinary incontinence.
17) The physician made an initial attempt to treat a male patient’s urethral stricture using a dilator.
18) The physician, in the first two stages to reconstruct the urethra identified the area of stricture by urethrography and marked it with ink.
19) The physician performed a transurethral destruction of the prostate using microwave therapy.
The physician excised a specimen of tis

Disorders of Veins and Arteries
Disorders of Veins and Arteries
Advanced practice nurses often treat patients with vein and artery disorders such as chronic venous insufficiency (CVI) and deep venous thrombosis (DVT). While the symptoms of both disorders are noticeable, these symptoms are sometimes mistaken for signs of other conditions, making the disorders difficult to diagnose. Nurses must examine all symptoms and rule out other potential disorders before diagnosing and prescribing treatment for patients. In this Assignment, you explore the epidemiology, pathophysiology, and clinical presentation of CVI and DVT.
To Prepare
· Review the section “Diseases of the Veins” (pp. 598-599) in Chapter 23 of the Huether and McCance text. Identify the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Consider the similarities and differences between these disorders.
· Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of CVI and DVT. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
· Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic venous insufficiency and one for venous thrombosis. Consider the epidemiology and clinical presentation of both chronic venous insufficiency and deep venous thrombosis.
To Complete
Write a 2- to 3-page paper that addresses the following:
· Compare the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Describe how venous thrombosis is different from arterial thrombosis.
· Explain how the patient factor you selected might impact the pathophysiology of CVI and DVT. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
· Construct two mind maps—one for chronic venous insufficiency and one for deep venous thrombosis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.
Required Readings
** Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Chapter 23, “Structure and Function of the Cardiovascular and Lymphatic Systems”
This chapter examines the circulatory system, heart, systemic circulation, and lymphatic system to establish a foundation for normal cardiovascular function. It focuses on the structure and function of various parts of the circulatory system to illustrate normal blood flow.
Chapter 24, “Alterations of Cardiovascular Function”
This chapter presents the pathophysiology, clinical manifestations, evaluation, and treatment of various cardiovascular disorders. It focuses on diseases of the veins and arteries, disorders of the heart wall, heart disease, and shock.
Chapter 25, “Alterations of Cardiovascular Function in Children”
This chapter examines cardiovascular disorders that affect children. It distinguishes congenital heart disease from acquired cardiovascular disorders.
** Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.
Chapter 11, “Cardiovascular Disorders: Vascular Disease”
This chapter begins with an overview of the vascular component of the cardiovascular system and how the cardiovascular system is normally regulated. It then describes three common vascular disorders: atherosclerosis, hypertension, and shock.
Instructor Requirements
As advanced practice nurses, we are scholars, nurse researchers and scientists. As such, please use Peer-Reviewed scholarly articles and websites designed for health professionals (not designed for patients) for your references. Students should be using the original citation in Up to Date and go to that literature as a reference. The following are examples (not all inclusive) of resources/websites deemed inadmissible for scholarly reference:
Up to Date (must use original articles from Up to Date as a resource)
Wikipedia
Cdc.gov- non healthcare professionals section
Webmd.com
Mayoclinic.com
– The work should have an Introduction and a Conclusion

Assignment: Sexual stimulation
Assignment: Sexual stimulation
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# 1.14
(1 pts.) Sandy is interested in sexual activity and does become sexually aroused. However, despite sexual stimulation, she cannot achieve orgasm. Sandy might have which sexual dysfunction?
A) female orgasmic disorder
B) vaginismus
C) dysorgasmia
D) hypoactive sexual desire disorder
# 1.15
(1 pts.) Karen and Mark are being treated for a sexual dysfunction and their therapist is urging them to take turns stimulating each in nonsexual ways for a few weeks. Their therapist is using which of the following methods?
A) the squeeze technique
B) the start-stop procedure
C) systematic resensitization
D) sensate focus
# 1.16
(1 pts.) Clark has recently become interested in being spanked before engaging in intercourse. He can become sexually aroused if he is not spanked but enjoys this as a sort of passing fancy. How might you describe dark’s condition?
A) He has a sexual dysfunction.
B) He has a paraphilia.
C) He is a sadist.
D) He does not necessarily have a sexual disorder.
# 1.17
(1 pts.) Bob has intense recurrent fantasies in which he is walking along the beach and a woman approaches. As she gets near, he unbuttons his pants and exposes his genitals to her. At that instant, she falls madly in love with him and they make love in the sand. Bob occasionally acts out these fantasies, and might be given the diagnosis of
A) sexual sadism.
B) exhibitionism.
C) transvestic fetishism.
D) frotteurism.
# 1.18
(1 pts.) A woman is erotically obsessed with men’s ankles to the point of exclusion of all other erotic stimuli. This woman’s desires are illustrative of
A) partialism.
B) sadism.
C) frotteurism.
D) voyeurism.
# 1.19
(1 pts.) Jeff has a compulsive desire to wear women’s clothes. He is able to achieve sexual arousal only when he cross-dresses. Jeff might be given the diagnosis of
A) sexual sadism.
B) voyeurism.
C) fetishism.
D) transvestic fetishism.
# 1.20
(1 pts.) In the 70s, Dr. Richard Raskin underwent a radical surgery in which his assigned sex was changed. He is now known as a woman named Renee Richards. Prior to the surgery Dr. Raskin might have been diagnosed as having
A) sexual aversion disorder.
B) gender identity disorder.
C) transvestic fetishism.
D) male erectile disorder.
# 1.21
(1 pts.) John gets nauseous when he thinks about having sexual intercourse and he actively avoids the sexual advances of others. John might be diagnosed as having
A) male erectile disorder.
B) sexual aversion disorder.
C) dyspareunia.
D) inhibited male orgasm disorder.
# 1.22
(1 pts.) Joseph experiences such intense and recurrent genital pain during sexual intercourse that even the thought of having sex is unbearable. Joseph might have
A) erectile disorder.
B) vaginismus.
C) dyspareunia.
D) inhibited male orgasm.
# 1.23
(1 pts.) Based on this information in the case report in the textbook, what assessment information might have led Dr. Tobin to conclude that Shaun Boyden was abused as a child?
A) His Rorschach responses indicated a great deal of impulsivity.
B) Shaun’s verbal IQ was somewhat higher than his performance IQ.
C) Shaun’s score on one of the MMPI lie scales indicated his responses were guarded.
D) His TAT stories contained themes of victimization.

Differential Diagnosis for Skin Conditions
Differential Diagnosis for Skin Conditions
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Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.
In this Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.
To prepare:
· Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Assignment.
· Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
· Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
· Consider which of the conditions is most likely to be the correct diagnosis, and why.
· Download the SOAP Template found in this week’s Learning Resources.
To complete:
· Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
· Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least 3 different references from current evidence based literature.

Assignment: symptoms of tachyarrhythmias
Assignment: symptoms of tachyarrhythmias
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Question 1
More than half of all cardiac arrhythmias involve the atria.
True
False
Question 2.
What are the most common symptoms caused by tachyarrhythmias?
Sweating
Thirst
Palpitations
Headaches
Question 3.
For women with known CAD and diabetes, which is most appropriate to assess CAD risk?
ETT
Coronary bypass surgery
Coronary catheterization
ETT with imaging
Question 4.
Of the following, which is the best answer when asked for an advantage of echocardiogram exercise testing over thallium stress testing?
Does not depend on operator experience
Costs are the same
Results are available more quickly
Doesn’t matter because there are no advantages
Question 5.
Your patient has uncomplicated pyelonephritis. In deciding your recommended treatment, you consider the most common pathogenic reason for this diagnosis. What pathogen accounts for the majority of pyelonephritis?
E. Coli
Gardnerella Vaginalis
Mycoplasma Hominis
Chlamydia
Question 6.
What purpose does the principle of fidelity serve in the provider/patient relationship?
Ensures that providers honor their commitments to the patient
Obligates the provider to a one-on-one relationship with the individual
Ensures that patients receive whatever they want
Maintains costs in the healthcare arena
Question 7.
In CAD, after both systolic and diastolic dysfunction have occurred, the typical pattern of chest pain and related EKG changes occur. During an EKG, you should expect to see ST-segment and T-wave changes that are central to demonstration of ischemia occurring relatively late in the ischemic cascade. Is this true or false?
True
False
Question 8.
The leads on the ECG showing ischemic changes during or immediately after an ETT can correlate roughly to the culprit artery or arteries with significant CAD. Is this true or false?
True
False
Question 9.
Skin cancer is the most common malignant neoplasm in males in the US. What is the second leading cause of cancer deaths in men greater than 50 years of age?
Prostate cancer
Lung cancer
Lymphoma
Lupus
Question 10.
What ECG changes can reduce the specificity of the ETT?
Exercise induced bundle branch blocks
Paced rhythm and resting bundle branch block
Paced rhythm and exercise induced bundle branch blocks
Low voltage up sloping of the ST-segment
Question 11.
You have confirmed that your patient does indeed have an abdominal aortic aneurysm. In teaching your patient about symptoms to report immediately to the vascular surgeon, you instruct the patient to report which of the following?
Newly diagnosed diabetes
Back pain or flank pain
Visual disturbances
Headaches
Question 12.
What is one of the common causes of a Saccular Abdominal Aneurysm?
Poor kidney functioning
Age
Drugs: illicit and prescribed
Trauma
Question 13.
The diagnostic accuracy of stress testing is decreased among women compared to men for what reasons?
Women having thinner ventricular and septal muscles
Women usually have single vessel or non-obstructive disease
Women cannot exercise as vigorously as men
Women typically have multiple vessel disease
Question 14.
Population disease management is a term used to describe:
High specificity disease states
Low specificity diseases states
Low prevalence specific diseases
High prevalence specific diseases
Question 15.
You receive a report back on the suspected abdominal aortic aneurysm for your patient. It confirms your suspicion of AAA. The report describes the aneurysm as a symmetric weakness of the entire circumference of the aorta. You know that this form of aneurysm is referred to as what kind of aneurysm?
Thoracic aneurysm
Budging sac aneurysm
Saccular aneurysm
Fusiform aneurysm
Question 16.
Your practice partner just ordered an exercise echocardiography 2DE for a patient with suspected cardiovascular risk. This patient has known resting wall motion abnormalities.Why would this not be the best test to assess this patient’s cardiac risk?
Sensitivity is increased
Sensitivity is decreased
Specificity is increased
Specificity is decreased
Question 17.
Your 60-year old male patient arrives for his appointment. He complains of general malaise and fever over the past several days with low back pain. He also states that he is getting up at night more often to urinate and never feels his bladder is completely empty.What differential diagnosis should you consider in this patient?
Acute viral prostatitis
Stomach virus
Acute bacterial prostatitis
BPH only
Question 18.
We all know that collaboration is integral to becoming a successful nurse practitioner. Among collaborations, however, only one can be considered as the most important. While each example below is important, which is the most important collaboration? The one that occurs:
Between the nurse practitioner and their physician mentor
Between two healthcare providers about a single patient
Between the patient and their family
Between the patient and the nurse practitioner
Question 19.
The sensitivity of a routine ETT is effort dependent. What physiological changes occur during effort in the routine ETT?
Rapid heart rates and coronary artery narrowing
Decrease in coronary blood flow
Decreased heart rate and increased systolic blood pressure
Increased coronary flow and increased systolic blood pressure
Question 20.
A 47-year old female with general complaints of fatigue and shortness of breath shows up in your clinic as a referral from another nurse practitioner. Several blood tests and chest x-rays have been completed without any diagnosis or outstanding abnormalities.You decide to order an ETT despite the fact that the recent ECG does not show any abnormalities. From the answers below, which would be the best answer to support your decision?
You are out of other options
CAD in women is under diagnosed
To please the patient
Women present with the same pattern of CAD as do males
Question 21.
Your patient underwent an exercise stress test for CAD. There is significant elevation of the ST-segment.What do you need to know about these changes to manage your patient’s care?
: This patient needs to see someone more experienced in treatment of CAD
These changes are predictive of myocardial infarction
These changes have minimal predictive value for CAD
These changes predict dire outcomes
Question 22.
When there is a consequential loss of structural integrity of the abdominal aorta, the resulting issue is what condition?
Bloated stomach
Kidney failure
Bleeding ulcers
Abdominal aortic aneurysm
Question 23.
You see a 60-year old African American male in your clinic with a recent diagnosis of hypertension. He asks you what he should restrict in his diet, and is particularly interested in limiting his sodium intake. What amount of sodium intake would you recommend on a daily basis for this patient?
1.5 g/day
No added table salt
3.0 g/day
2.3 g/day
Question 24.
Why would inability to exercise reduce the specificity of the routine ETT?
Produces QRS changes that cannot be interpreted
Produces persistent ST-segmental changes and T-wave abnormalities
Causes ST-segment changes and P-wave abnormalities
Will not produce any changes in ECG
Question 25.
By standard criteria, how is a positive stress test defined?
Development of a horizontal or down sloping ST-segment depression of 1mm
Down sloping of the ST-segment at the J point of the QRS
Development of a horizontal or down sloping ST-segment depression of 10mm
Upward sloping ST-segment measured at the J point of the QRS
Question 26.
What are the two types of bradycardia recognized by the American Heart Association?
Relative and absolute
Absolute and pending
Refractory and non-refractory
Relative and dynamic
Question 27.
You see a 75-year old female in your clinic today complaining of urinary incontinence. She is otherwise healthy based upon her last visit. She states that her mother told her this would happen someday because it happens to every woman at some age. What would you tell this patient?
This happens to all women as they age
No need to worry. This is normal. Your mother was correct.
This is not an expected condition related to aging.
This happens to men as well and most women before your age.
Question 28.
What do you know regarding ischemia that is confined to only the posterior and or lateral segments of the left ventricle?
ETT cannot be used for detection
Difficult to detect by ETT
Requires both for detection of changes by ETT
Easier to detect by ETT
Question 29.
What three conditions definitely alter the results of echocardiography in determining CAD?
Obesity, rapid heart rate and lung disease
Diabetes, kidney disease and tooth decay
Obesity, slow heart rates and hypertension
Previous MI, hypotension and diabetes
Question 30.
Specifically, when is an ETT considered to be negative?
Patient has ST-segmental changes with down sloping of greater than 1 mm at 50% of age-predicted maximum heart rate
Patient exercises to 85% of age predicted maximum heart rate without evidence of induced ischemia
Patient exercises to 20% maximum age-predicted heart rate without induced ischemia
Patient exercises until tired without evidence of induced ischemia
Question 31.
All patients, even is asymptomatic, require risk stratification according to the Farmingham risk score. At present, ACC/AHA guidelines, however, do not normally support stress tests for asymptomatic patients without addiitonal justification. From the list below, what could be used to justify a ETT in an asymptomatic patient?
A smoker of 3 weeks
A member of congress
Sedentary and wishes to begin aggressive exercise
Developmentally challenged
Question 32.
BPH is not a risk factor for Prostate cancer. Is this statement true or false?
True
Question 33.
Spread of genital herpes only occurs during the time period with active lesions. Is this statement true or false?
True
False(not confirm)
Question 34.
Abdominal aortic aneurysms are often asymptomatic. What percent of AAA’s are discovered in asymptomatic patients?
40%
20%
10%
75%
Question 35.
Improvements in the delivery and management of healthcare are necessary if we are to improve the overall health of this nation’s population. Which of the following are identified in your readings as strategic in the movement to improve the healthcare system?
President and Congress
Population management and healthcare practice
Socialized medicine and governmental controls
Monetary savings and limited disruption in healthcare delivery
Question 36.
What are the two main types of heart failure?
Systolic and diastolic
Hopeless and severe
Left sided and main
End diastolic and pressure related
Question 37.
The majority of all strokes are non-ischemic. Is this statement true or false?
True
False
Question 38.
When a murmur is first heard, it is important to determine if it is due to a pathological condition or benign. For an experienced practitioner, it is always easy to determine the cause of a murmur merely by listening to the sound. Is this statement true or false?
True
False
Question 39.
Maintenance of an Isometric ST-segment during exercise is the response of?
A normal heart
Hypo profusion
An abnormal heart
CAD
Question 40.
The goal of self-management is to specifically do what?
Engage patients in their own care
Engage insurance providers in patient care
Engage providers in patient care
Engage government in greater involvement in patient care
Question 41.
Your 56-year old patient presents with bradycardia with a rate of 55 and first degree AV block. The patient is hemodynamically stable and is not experiencing any syncope or chest pain. History includes previous myocardial infarction. Home medications include beta blockers, daily aspirin. Lab work is non-significant for electrolyte imbalance. You decided to treat this patient for the arrhythmia to prevent future destabilization. From the choices below, which might be the appropriate first measure to consider?
Add digitalis to control the heart rate
Consult cardiologist immediately for guidance
Discontinue Beta Blocker and replace with another therapy if necessary
Atropine injections
Question 42.
Your patient is morbidly obese and cannot sit on a bicycle or walk a treadmill. She also has marked and severe emphysema. You need to make an assessment of the risk of significant CAD and your patient’s family says that their relative had their diagnosis based on an ultrasound echocardiography. What facts would influence your decision regarding the family request for echo assessment?
Sensitivity would be increased because of lung disease
Specificity would be increased because of obesity
Sensitivity would be reduced because of obesity and lung disease
Specificity would be reduced because of obesity and lung disease
Question 43.
You are in the clinic with your mentor observing the Echocardiogram exercise test of a 45-year old male that has been experiencing slight chest pressure almost daily during exercise.While observing your patient, your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of the ventricular wall. From your time in the clinic, you know that this test will be considered to be what type of result?
Negative
Impossible
Positive
Non-readable
Question 44.
Your patient is newly diagnosed with persistent Atria Fibrillation. You consider electrocardioversion. Before undergoing this procedure you should order the following examination to assess thrombus risk.
X-Ray of chest
Tranesophageal echocardiography
Ultrasound of chest
CT Scan
Question 45.
Tachyarrhythmias cause a drop in commonly blood pressure, cardiac output, syncope, shortness of breath, and chest pain. What phenomenon most often occurs during these arrhythmias to cause these symptoms?
Shortened diastole
Lengthened diastole
Lengthened systole
Shortened systole
Question 46.
At what age is atria fibrillation most common?
In childhood
60 years or older
30 years
45 years
Question 47.
Automaticity is a property common to all cardiac cells. Is this statement true or false?
True
False
Question 48.
Your patient has a maximum age-predicted heart rate of 180. During the exercise he reaches a heart rate of 140 and then states he can no longer exercise. You see evidence of ischemic changes on the ECG. This would be predictive of what condition?
Stroke
Significant CAD
Impending death
Low risk of CAD
Question 49.
You tell a patient that he has a murmur. He says he has been told this before, but wonders what causes the unique sounds of a murmur. Which of the following would be your best option?
Turbulent flow of blood
High pressures caused from HTN
There is no reason, it just happens
Almost always from a sclerotic valve
Question 50.
What is the treatment of choice for uncomplicated community-acquired cystitis?
TMP-SMZ
Any antibiotic will treat this diagnosis
Amoxicillin
Penicillin
Question 51.
Any patient presenting with symptomatic bradycardia should be referred
to a cardiologist for management. Is this statement true or false?
True
False
Question 52.
Encouragement of patients to take effective actions in their own healthcare refers to the concept of:
Self-management support
Interprofessional support
Physician or provider-driven care
Family care givers
Question 53.
You are considering adding an adjunctive form of testing to detect wall motion abnormalities during the ETT.You select Echocardiography as the added testing. You choose this test because you know that echocardiography does what when added to a standard ETT?
Enhances sensitivity and specificity of CAD detection
Enhances sensitivity while reducing specificity of CAD detection
Enhances specificity while not changing sensitivity of detection for CAD
You like pretty pictures of wall motion
Question 54.
Medicaid is mandated to be provided by each state through federal codes. Each state must offer Medicaid exactly as the federal government prescribes. True or false?
True
False
Question 55.
What sexually transmitted disease is most widespread in the USA today?
Chlamydia
Gonorrhea
Syphilis
HIV/AIDS
Question 56.
Your preceptor decides to add Doppler Flow studies to the echocardiogram exercise test for a patient with a recent history of a holistic murmur best auscultated at the left steral boarder. The patient has no history of cardiac surgeries. He asks you what might be the main advantages of adding Doppler Flow for this particular patient. You know from your readings that there are several reasons to add Doppler Flow and below are listed more than one correct reason. Your best response for this specific case, however, would be that Doppler Flow studies would be of what additive value during the echocardiogram study?
Detect and evaluate blood shunting from a septal defect
No advantage is seen for this patient
Gives better screen shots of wall abnormalities
Provides assessment of prosthetic valve function
Question 57.
Sexual partners of a patient with a diagnosed STI should always be examined and treated. Is this statement true or false?
True
False
Question 58.
Your patient presents with tachycardia. The QRS is measured at 0.10 seconds. Which of the following tachycardias would be an appropriate conclusion based on this information alone?
Ventricular tachycardias
Premature junctional contractions
Atria fibrillation
Ventricular fibrillation
Question 59.
A 65-year old white male arrives in your clinic with general complaints of slight abdominal discomfort. He has a known history of smoking two packs per day for 40 years and hypertension. He also has COPD and has been treated numerous times with oral steroids. You consider several optional diagnoses. Of the ones listed below, which should be included as a potential top suspect in your choice of diagnosis?
Chronic bowel obstruction
Meglacolon
Appendicitis
Abdominal aortic aneurysm
Question 60.
What are the most common mechanisms to produce cardiac arrhythmias?
Decreased automaticity, triggered activity or reentry
Reentry, electrical dysfunction or activity
Stress, hard work or swimming
Enhanced automaticity, triggered activity or reentry

Discussion: Assessing Muscoskeletal Pain
Discussion: Assessing Muscoskeletal Pain
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Note: Your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to the Comprehensive SOAP Template in the attachments below for guidance.
CASE: Knee Pain
A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?
To prepare:
With regard to the case study you were assigned:
· Review this week’s Learning Resources, and consider the insights they provide about the case study.
· Consider what history would be necessary to collect from the patient in the case study you were assigned.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
Address all these in the SOAP Note not an Narrative Essay (Follow the SOAP Note Template on the attachment):
1. A description of the health history you would need to collect from the patient in the case study to which you were assigned.
2. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis.
3. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
4. Include how the patient X-ray helped you to refine the differential diagnosis
REMINDER:Please make a SOAP NOTE for this case. Make your own patient’s data, applicable health history, review of systems, P.E., labs, differential diagnosis, final diagnosis etc. Incorporate the data from the case in the SOAP note that you will do… This is not a narrative essay ok…. I need SOAP note (Nurse Practitioner/RN/MD makes SOAP note)… Be guided with the SOAP Note in the templates/exemplar… Don’t copy paste. Formulate your own… Don’t forget to cite the Five different possible conditions (Differential diagnosis) and have Reference lists too.
Resources:
· Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
o Review of Chapter 4, “Vital Signs and Pain Assessment” (pp. 50-63)
o Chapter 21, “Musculoskeletal System” (pp. 501-543)
This chapter describes the process of assessing the musculoskeletal system. In addition, the authors explore the anatomy and physiology of the musculoskeletal system.
· Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
o Chapter 22, “Limb Pain” (pp. 356-374)
This chapter outlines how to take a focused history and perform a physical exam to determine the cause of limb pain. It includes a discussion of the most common tests used to assess musculoskeletal disorders.
o Chapter 24, “Low Back Pain (Acute)” (pp. 288-300)
The focus of this chapter is the identification of the causes of lower back pain. It includes suggested physical exams and potential diagnoses.
· Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
o Chapter 2, “The Comprehensive History and Physical Exam” (“Muscle Strength Grading”; p. 26)
o Chapter 4, “Pediatric Preventative Care Visits” (“Documentation of Important Components of Age Specific Physical Exams and Sports Pediatric Sports Participation Physical Exam”; pp. 78–79)
Note: Download this Adult Examination Checklist and Physical Exam Summary: Abdomen to use during your practice musculoskeletal examination.
· Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011).. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
This Adult Examination Checklist: Guide for Musculoskeletal Assessment was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
· Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011).. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
This Musculoskeletal System Physical Exam Summary was published as a companion to Seidel’s guide to physical examination(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
· Katz, J. N., Lyons, N., Wolff, L. S., Silverman, J., Emrani, P., Holt, H. L., & …Losina, E. (2011). Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study. BMC Musculoskeletal Disorders, 12(1), 78–85.
Retrieved from the Walden Library databases.
This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.
· Vismara, L., Menegoni, F., Zaina, F., Galli, M., Negrini, S., & Capodaglio, P. (2010). Effect of obesity and low back pain on spinal mobility: A cross sectional study in women. Journal of Neuroengineering & Rehabilitation, 7(1), 71–83.
Retrieved from the Walden Library databases.
In this study, the authors explore the effect of obesity and chronic low back pain on spinal mobility. The authors use range of motion as a metric of spinal mobility.
· University of Virginia. (n.d.). Introduction to radiology: An online interactive tutorial. Retrieved from
This website provides an introduction to radiology and imaging. For this week, focus on skeletal trauma in musculoskeletal radiology.
Media
Online media for Seidel’s Guide to Physical Examination
In addition to this week’s resources, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 21 that relate to the assessment of the musculoskeletal system. Refer to the Week 4 Learning Resources area for access instructions on .
Optional Resources
· LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.
o Chapter 13, “The Spine, Pelvis, and Extremities” (pp. 585–682)
In this chapter, the authors explain the physiology of the spine, pelvis, and extremities. The chapter also describes how to examine the spine, pelvis, and extremities.