We can work on Week 5 Midterm NSG 6420

Week 5 Midterm NSG 6420

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 A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of Digital rectal examination       Endoscopy       Pelvic examination       UrinalysisDefinition Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? A Clinical practice guideline     b  Clinical decision rule     c  Clinical algorithm     d  Clinical recommendation A common auscultatory finding in advanced CHF is     S3 gallop rhythm Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.  The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point? A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered? Def Mono spot       Strep test       Throat culture       All of the above Which of the following is not a contributing factor to the development of esophagitis in older adults? Essential parts of a health history include all of the following except: What test is used to confirm the diagnosis of appendicitis? The first assessment to complete related to the eyes is       Eye lids       Visual acuity       Extraocular movements       Peripheral vision The best way to diagnose structural heart disease/dysfunction non-invasively is Chest X-ray               EKG         CORRECT  Echocardiogram               Heart catheterization Which of the following is considered a “red flag” when diagnosing a patient with pneumonia Fever of 102     Infiltrates on chest X-ray     Pleural effusion on chest X-ray     Elevated white blood cell count In a patient presenting with suspected recurrence of diverticulitis, abdominal pain usually presents where in the abdomen? Left upper quadrant       Right upper quadrant       Left lower quadrant       Right lower quadrant Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms Acute MI       GERD       Pneumonia       Angina In autosomal recessive (AR) disorders, individuals need Only one mutated gene on the sex chromosomes to acquire the disease       Only one mutated gene to acquire the disease       Two mutated genes to acquire the disease       Two mutated genes to become carriers Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? chronic bronichitis The best evidence rating drugs to consider in a post myocardial infarction patient include: ASA, ACE/ARB, beta-blocker, aldosterone blockade       ACE, ARB, Calcium channel blocker, ASA       Long-acting nitrates, warfarin, ACE, and ARB       ASA, clopidogrel, nitrates A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: Lung cancer     Tuberculosis     Pneumonia     COPD Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to       Pneumothorax       Pleural effusion       Pneumonia       Pulmonary embolism A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: Bacterial conjunctivitis B.  Allergic conjunctivitis C.  Chemical conjunctivitis D.  Viral conjunctivitis Emphysematous changes in the lungs produce the following characteristic in COPD patients? Asymmetric chest expansion       Increased lateral diameter       Increased anterior-posterior diameter       Pectus excavatum An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD? A.  Identification of a fluid wave B.  Positive Murphy’s sign C.  Palpable spleen D.  Midepigastric pain that is not reproducible with palpation Which of the following details are NOT considered while staging asthma? A.  Nighttime awakenings B.  Long-acting beta agonist usage C.  Frequency of symptoms D.  Spirometry findings The cytochrome p system involves enzymes that are generally Inhibited by drugs :     Inhibited by drugs     Induced by drugs     Inhibited or induced by drugs     Associated with decreased liver perfusion Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.  Of the following lab studies, which would provide little help in determining your differential diagnosis?       Abdominal plain films       Liver function tests       Amylase/lipase       Urinalysis Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of: Angina       Pericarditis       Mitral valve prolapse       Congestive heart failur Men have faster and more efficient biotransformation of drugs and this is thought to be due to:     Less obesity rates than women     Prostate enlargement     Testosterone     Less estrogen than women An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: Mallory-Weiss tear B.  Esophageal varices C.  Gastric ulcer D.  Colon cancer You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? Ménière’s disease             Benign paroxysmal positional vertigo             Transient ischemic attack (TIA)             MigraineDefinition . Your patient has been treated for glaucoma for 5 years. Which of the following will provide indication of the level of progression during the funduscopic examination for this patient? Checking the macula       Estimating cup-to-disk ratio

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Paper, Order, or Assignment Requirements

 A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of Digital rectal examination       Endoscopy       Pelvic examination       UrinalysisDefinition Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? A Clinical practice guideline     b  Clinical decision rule     c  Clinical algorithm     d  Clinical recommendation A common auscultatory finding in advanced CHF is     S3 gallop rhythm Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.  The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point? A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered? Def Mono spot       Strep test       Throat culture       All of the above Which of the following is not a contributing factor to the development of esophagitis in older adults? Essential parts of a health history include all of the following except: What test is used to confirm the diagnosis of appendicitis? The first assessment to complete related to the eyes is       Eye lids       Visual acuity       Extraocular movements       Peripheral vision The best way to diagnose structural heart disease/dysfunction non-invasively is Chest X-ray               EKG         CORRECT  Echocardiogram               Heart catheterization Which of the following is considered a “red flag” when diagnosing a patient with pneumonia Fever of 102     Infiltrates on chest X-ray     Pleural effusion on chest X-ray     Elevated white blood cell count In a patient presenting with suspected recurrence of diverticulitis, abdominal pain usually presents where in the abdomen? Left upper quadrant       Right upper quadrant       Left lower quadrant       Right lower quadrant Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms Acute MI       GERD       Pneumonia       Angina In autosomal recessive (AR) disorders, individuals need Only one mutated gene on the sex chromosomes to acquire the disease       Only one mutated gene to acquire the disease       Two mutated genes to acquire the disease       Two mutated genes to become carriers Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? chronic bronichitis The best evidence rating drugs to consider in a post myocardial infarction patient include: ASA, ACE/ARB, beta-blocker, aldosterone blockade       ACE, ARB, Calcium channel blocker, ASA       Long-acting nitrates, warfarin, ACE, and ARB       ASA, clopidogrel, nitrates A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: Lung cancer     Tuberculosis     Pneumonia     COPD Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to       Pneumothorax       Pleural effusion       Pneumonia       Pulmonary embolism A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: Bacterial conjunctivitis B.  Allergic conjunctivitis C.  Chemical conjunctivitis D.  Viral conjunctivitis Emphysematous changes in the lungs produce the following characteristic in COPD patients? Asymmetric chest expansion       Increased lateral diameter       Increased anterior-posterior diameter       Pectus excavatum An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD? A.  Identification of a fluid wave B.  Positive Murphy’s sign C.  Palpable spleen D.  Midepigastric pain that is not reproducible with palpation Which of the following details are NOT considered while staging asthma? A.  Nighttime awakenings B.  Long-acting beta agonist usage C.  Frequency of symptoms D.  Spirometry findings The cytochrome p system involves enzymes that are generally Inhibited by drugs :     Inhibited by drugs     Induced by drugs     Inhibited or induced by drugs     Associated with decreased liver perfusion Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.  Of the following lab studies, which would provide little help in determining your differential diagnosis?       Abdominal plain films       Liver function tests       Amylase/lipase       Urinalysis Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of: Angina       Pericarditis       Mitral valve prolapse       Congestive heart failur Men have faster and more efficient biotransformation of drugs and this is thought to be due to:     Less obesity rates than women     Prostate enlargement     Testosterone     Less estrogen than women An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: Mallory-Weiss tear B.  Esophageal varices C.  Gastric ulcer D.  Colon cancer You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? Ménière’s disease             Benign paroxysmal positional vertigo             Transient ischemic attack (TIA)             MigraineDefinition . Your patient has been treated for glaucoma for 5 years. Which of the following will provide indication of the level of progression during the funduscopic examination for this patient? Checking the macula       Estimating cup-to-disk ratio

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