NR 507 Final Exam (100% Correct)
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Question 1. What term is used to describe a hernial protrusion of a saclike cyst that contains meninges, spinal fluid, and a portion of the spinal cord through a defect in a posterior arch of a vertebra? Question 2. What provides the best estimate of the functioning of renal tissue? Question 3.
Where are Langerhans cells found?
Question 4.
Where in the lung does gas exchange occur?
Question 5. The tonic neck reflex observed in a newborn should no longer be obtainable by: Question 6. action?
When renin is released, it is capable of which
Question 7. The portion of the antigen that is configured for recognition and binding is referred to as what type of determinant?
Question 8. Which sexually transmitted infection frequently coexists with gonorrhea? Question 9. measured?
How is the effectiveness of vitamin B12 therapy
Question 10. Carcinoma refers to abnormal cell proliferation originating from which tissue origin? Question 11. skin?
Which type of microorganism reproduces on the
Question 12. An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. A wide fixed splitting of the second heart sound is also found. These clinical findings are consistent with which congenital heart defect? Question 13. An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom? Question 14.
What is the function of erythrocytes?
Question 15. Which terms represent the correct nomenclature for benign and malignant tumors of adipose tissue, respectively? Question 16. What is the chance with each pregnancy that a child born to two parents with the sickle trait will have sickle cell disease (SCD)? Question 17. What pulmonary defense mechanism propels a mucous blanket that entraps particles moving toward the oropharynx? Question 18. The concentration of the final urine is determined by antidiuretic hormone (ADH), which is secreted by which gland?
Question 19. Why is the herpes virus inaccessible to antibodies after the initial infection? Question 20.
Which renal change is found in older adults?
Question 21. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? Question 22. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? Question 23. Which statement is true regarding maternal antibodies provided to the neonate? Question 24.
The function of the tumor cell marker is to:
Question 25. infection?
Which statement is true concerning a fungal
Question 26. Which change is a result of puberty and defends the vagina from infection? Question 27. The number of persons living with a specific disease at a specific point in time is referred to by which term? Question 28. Which risk factor for hypertension is influenced by genetic factors and lifestyle? Question 29. Having ejected a mature ovum, the ovarian follicle develops into a(n): Question 30. The failure of bones to ossify, resulting in soft bones and skeletal deformity, characterizes which disorder? Question 31. What is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding?
Question 32.
Aldosterone directly increases the reabsorption of:
Question 33. Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke? Question 34. fibromyalgia?
Which clinical manifestations are associated with
Question 35. Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation? Question 36.
What is the leading cause of infertility in women?
Question 37. hormone?
Which substance is a water-soluble protein
Question 38. factor?
What is the target tissue for prolactin-releasing
Question 39. What is the cause of familial hypercholesterolemia (FH)? Question 40. Regarding type 2 diabetes, obesity is considered to be what type of risk? Question 41. muscle contraction?
Which four-step process correctly describes
Question 42. Adoption studies have shown that the offspring of an alcoholic parent when raised by nonalcoholic parents have what amount of an increased risk of developing alcoholism? Question 43. Which hormone stimulates gonads to produce both male and female hormones?
Question 44. A person with 47, XXY karyotype has the genetic disorder resulting in which syndrome? Question 45. of schizophrenia?
Which would be considered a positive symptom
Question 46. What term describes the loss of the comprehension or production of language? Question 47.
Consanguinity refers to the mating of persons:
Question 48. of the brain?
The major sleep center is located in which section
Question 49. Which type of ion directly controls the contraction of muscles? Question 50. which means?
Bacteria gain access to the female urinary tract by
Question 51. A criterion for a diagnosis of generalized anxiety disorder (GAD) is a period of excessive worrying that lasts for at least how many months? Question 52. in children?
What is the first indication of nephrotic syndrome
Question 53. An amniocentesis indicates a neural tube defect when an increase in which protein is evident? Question 54. dominant diseases?
What is the risk for the recurrence of autosomal
Question 55. Which term is used to identify the temporary displacement of two bones causing the bone surfaces to partially lose contact?
Question 56.
The tear in a ligament is referred to as a:
Question 57. Why is prolonged diarrhea more severe in children than it is in adults? Question 58. The BRCA1 and BRCA2 mutations increase the risk of which cancer in women? Question 59.
Insulin transports which electrolyte in the cell?
Question 60. What term is used to identify an interlacing bundle of dense, white fibrous tissue that is richly supplied with nerves, blood vessels, and lymphatic vessels? Question 61.
Which of the following is a lipid-soluble hormone?
Question 62. The mucosal secretions of the cervix secrete which immunoglobulin? Question 63. The sudden apparent arousal in which a child expresses intense fear or another strong emotion while still in a sleep state characterizes which sleep disorder? Question 64.
What is the basic structural unit in compact bone?
Question 65. the brain’s:
Parkinson disease is a degenerative disorder of
Question 66. Which pain theory proposes that a balance of impulses conducted from the spinal cord to the higher centers in the central nervous system (CNS) modulates the transmission of pain? Question 67.
Saliva contains which immunoglobulin (Ig)?
Question 68. What type of fracture occurs at a site of a preexisting bone abnormality and is a result of a force that would not normally cause a fracture?
Question 69. An infant suddenly develops abdominal pain, becomes irritable (colicky), and draws up the knees. Vomiting occurs soon afterward. The mother reports that the infant passed a normal stool, followed by one that looked like currant jelly. Based on these data, which disorder does the nurse suspect? Question 70. In 95% of children of delayed puberty, the problem is caused by: Question 71. Which characteristic is true of type II (white fastmotor) muscle fibers? Question 72. Neurofibrillary tangles characterize which neurologic disorder? Question 73.
Which hormone triggers uterine contractions?
Question 74. How does the release (increase) of epinephrine raise body temperature? Question 75. Which hormone is linked to an increase in appetite during puberty?
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NR 507 Week 1 Discussions Altered Immune System and Altered Inflammatory Response
For more course tutorials visit uophelp.com is now newtonhelp.com www.newtonhelp.com Week 1: Altered Immune System and Altered Inflammatory Response
Part One
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
Discussion Part One (graded)
John is a 19-year-old college football player who presents with sneezing, itchy eyes, and nasal congestion that worsens at night. He states that he has a history of asthma, eczema and allergies to pollen. There is also one other person on the football team that has similar symptoms. His vitals are BP 110/70, P 84, R 18, T 100 F. Write a differential of at least five (5) possible items from the most likely to less likely. For each disease include information about the epidemiology, pathophysiology and briefly argue why this disease fits the presentation and why it might not fit the presentation Week 1: Altered Immune System and Altered Inflammatory Response
Discussion Part Two
A patient has been admitted into the emergency room that was in the passenger side of a car that collided with another car head on. The patient is pale, barely conscious and has a weak and thread pulse. An IV is started. The vitals are BP 80/50, P 140, T 96.0 and R 26. As the team fights to keep the patient alive they have to remove the spleen. Blood is given but it has been mistyped. A transfusion reaction occurs. Describe the type of hypersensitivity reaction that has occurred and discuss the molecular pathophysiology of the specific type of hypersensitive reaction you have chosen.
In the event that this patient survived the car accident and the transfusion reaction which organs are most likely to be damaged and why?
Discussion Part Three
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1,
4 Distinguish risk factors associated with selected disease states.(PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
Discussion
A 44-year-old patient presents with lump in the chest of approximately 2 cm in diameter. There is a slight dimple over the location of the lump and when the lump is manipulated it seems to be attached to the surrounding tissue. A lumpectomy is performed and the mass is sent to pathology. The pathology report comes back and the mass is confirmed to be an estrogen receptor negative, a progesterone receptor negative and a her2/neu receptor positive breast cancer.
What are some of the risk factors for breast cancer? What tumor suppressor genes are associated with breast cancer?
What tumor oncogenes are associated with breast cancer?
Compare and contrast tumor suppressor genes from oncogenes?
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NR 507 Week 2 Discussions Respiratory Disorders and Alterations in Acid/Base Balance,Fluid and Electrolytes
For more course tutorials visit uophelp.com is now newtonhelp.com www.newtonhelp.com Week 2: Respiratory Disorders and Alterations in Acid/Base Balance,
Fluid and Electrolytes – Discussion Part One
This week’s graded topics relate to the following Course Outcomes (COs).
Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
Distinguish risk factors associated with selected disease states. (PO1)
Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
Distinguish risk factors associated with selected disease states. (PO1)
Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
Discussion Part One (graded)
A five-month-old Caucasian female is brought into the clinic as the parent complain that she has been having ongoing foul-smelling , greasy diarrhea. She seems to be small for her age and a bit sickly but, her parent’s state that she has a huge appetite. Upon examination you find that the patient is wheezing and you observe her coughing.
Write a differential diagnosis of at least five (5) disorders and explain why each might be a possibility and any potential weaknesses of each differential.
Why is it that the later in age this disease manifest itself, the less severe the disease is?
What tests would you run to clarify your differential and potentially come to a definitive diagnosis? If the same child was African in ancestry would this change your initial differential? Why or why not?
Week 2: Respiratory Disorders and Alterations in Acid/Base Balance, Fluid and Electrolytes
Discussion Part Two
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
Tammy is a 33-year-old who presents for evaluation of a cough. She reports that about 3 weeks ago she developed a “really bad cold” with rhinorrhea. The cold seemed to go away but then she developed a profound, deep, mucus-producing cough. Now, there is no rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Tammy has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.
Write a differential of at least five (5) possible diagnosis’s and explain how each may be a possible answer to the clinical presentation above.
Remember, to list the differential in the order of most likely to less likely.
Based upon what you have at the top of the differential how would you treat this patient?
Suppose now, the patient has a fever of 100.4 and complains of foul smelling mucous and breath. Indeed, she complains of producing cups of mucous some days. She has some trouble breathing on moderate exertion but this is only a minor complaint to her. How does this change your differential and why?
Discussion Part Three
This week’s graded topics relate to the following Course Outcomes (COs).
Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
Distinguish risk factors associated with selected disease states.
Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
Distinguish risk factors associated with selected disease states. (PO
Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
A nursing student comes into your office because they are struggling with the concept of pulmonary function. They know you as an experienced FNP and so they are comfortable asking if you could clarify the terms residual volume (RV), functional reserve capacity (FRC), total lung capacity (TLC) inspiratory reserve volume (IRV), and expiratory reserve volume (ERV).
Give her a definition of each?
List three (3) disorders that can alter the residual volume and explain how they do so?
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NR 507 Week 3 Discussions Cardiovascular, Cellular, and Hematologic Disorders
For more course tutorials visit uophelp.com is now newtonhelp.com www.newtonhelp.com Week 3: Cardiovascular, Cellular, and Hematologic Disorders
Discussion Part One
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states
A 17-year-old African American from the inner city complains of severe chest and abdominal pain. Upon examination the attending physician performs and EKG, chest x-ray, and an abdominal and chest clinical examination and finds nothing. Assuming, she is drug seeking he sends her home. She comes back to the ER 4 hours later and now you see the patient. She explains that she was running track this past afternoon at school and that despite being very hot (100 F) she pushed on. Afterwards, she starts feeling extensive pain in her chest and abdomen. She has jaundiced eyes, her blood pressure is 98/50, pulse is 112, T = 99.9 F, R = 28. The pain seems out of proportion to the physical findings.
What is your list of differential diagnoses in this case and explain how each of these fits with the case patient as described above. Be sure to list at least four (4) pertinent differential diagnoses. Indicate which of these you would select as the most likely diagnosis and explain why.
Now, as she is in the ER she begins to exhibit stroke like features. ? Does this change your differential? How do you treat this patient now? Are they any preventative actions that could have been taken?
Discussion Part Two
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
Jesse is a 57-year-old male who presents with gradual onset of dyspnea on exertion and fatigue. He also complains of frequent dyspepsia with nausea and occasional epigastric pain. He states that at night he has trouble breathing especially while lying on his back. This is relieved by him sitting up. His vitals are 180/110, P = 88, T = 98.0 C, R = 20.
Write a differential in this case and explain how each item in your differential fits and how it might not fit.
What tests would you order? What immediate treatment would you consider giving this patient and what treatment when he went home? Assume your first differential is definitive.
Now, he comes back to your clinic 3 months later and both his ankles are slightly swollen. What possible explanations are there for this observation?
Discussion Part Three
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
A new patient is brought into the office for their annual evaluation. The child is a 6-year-old and appears a bit small for their age but not so small that any alarm bells are set off. The vitals are: P = 116, R = 22, T = 98.6 , BP = 110/50. (The normal vitals in a 6-year-old are P = 75 – 120, R = 16 – 22, T = 98.6 , BP = (85-115)/(48-64).
Examination of the lungs is normal, HEENT is normal, as is the abdominal exam. The heart however, seems laterally displaced and there appears to be only a continuous murmur which can be described as crescendo/decrescendo systolic murmur that extends into diastole. Because, you were trained at Chamberlain College of Nursing you immediately know that this is probably a patent ductus arteriosus.
Explain the murmur from a mechanistic view of the hearts physiological functioning?
What is the epidemiology of a patent ductus arteriosus?
How is a patent ductus arteriosus treated?
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NR 507 Week 3 Quiz
For more course tutorials visit uophelp.com is now newtonhelp.com www.newtonhelp.com For any Change in Questions Just Contact us, I will Take care of your Quiz Question 1.1. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? (Points : 0.4)
A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity. The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies. Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording. Holter monitors are normally set to record electrical activity of the heart at least once per hour. Question 2.2. As part of the diagnostic workup for a male patient with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements, and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? (Points : 0.4)
Echocardiogram, PET scan, ECG Ambulatory ECG, cardiac MRI, echocardiogram Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy Cardiac catheterization, cardiac CT, exercise stress testing Question 3.3. An 81-year-old female patient of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the patient has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous
distention a useful indicator for the assessment of the patient’s condition? (Points : 0.4)
Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest. Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. Peripheral dilation is associated with decreased stroke volume and ejection fraction. Heart valves are not capable of preventing backflow in cases of atrial congestion. Question 4.4. A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect? (Points : 0.4)
Pheochromocytoma Essential hypertension Coarctation of the aorta An adrenocortical disorder Question 5.5. A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was “so fast I couldn’t even count it.” The child was determined to be in
atrial flutter and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother? (Points : 0.4)
The child is experiencing a reentry rhythm in his right atrium. The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions. The child is likely to have a normal ECG apart from the rapid heart rate. The boy’s atria are experiencing abnormal sympathetic stimulation. Question 6.6. A 66-year-old patient’s echocardiogram reveals a hypertrophied left ventricle, normal chamber volume, and a normal ejection fraction from the heart. What is this patient’s most likely diagnosis? (Points : 0.4)
Mitral valve regurgitation Aortic valve stenosis Mitral valve stenosis Aortic valve regurgitation Question 7.7. A 70-year-old male patient presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. What would his care provider’s preliminary diagnosis and anticipated treatment most likely be?(Points : 0.4)
Acute arterial occlusion that will be treated with angioplasty Raynaud disease that will require antiplatelet medications Atherosclerotic occlusive disease necessitating thrombolytic therapy Giant cell temporal arteritis that will be treated with corticosteroids Question 8.8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 0.4)
Hypovolemic shock Septic shock Neurogenic shock Obstructive shock Question 9.9. A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia and she is suspected of having sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? (Points : 0.4)
Signal-averaged ECG Exercise stress testing
Electrophysiologic study Holter monitoring Question 10.10. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? (Points : 0.4)
A 61-year-old man who has a heart valve infection and recurrent fever An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance Question 11.11. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)
Increased preload due to vascular resistance High afterload because of backpressure against the left ventricle Impaired contractility due to aortic resistance Systolic impairment because of arterial stenosis Question 12.12. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily
indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)
A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest Question 13.13. A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks’ gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her? (Points : 0.4)
Plasma angiotensin I and II and renin Urinary sodium and potassium Platelet count, serum creatinine, and liver enzymes Urinary catecholamines and metabolites Question 14.14. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests.
What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0.4)
BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology. BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure. BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia. BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects. Question 15.15. The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following teaching points best conveys an aspect of the human circulatory system? (Points : 0.4)
“Your blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation.” “Only around one quarter of your blood is in your heart at any given time.” “Blood pressure and blood volume roughly mimic one another at any given location in the circulatory system.”
“Left-sided and right-sided pumping action at each beat of the heart must equal each other to ensure adequate blood distribution.” Question 16.16. A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his nurse practitioner. The patient’s nurse practitioner would anticipate that which of the following phenomena is most likely occurring? (Points : 0.4)
The patient’s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation. Epinephrine from his adrenal gland is initiating the renin-angiotensinaldosterone system. Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction. The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption. Question 17.17. A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? (Points : 0.4)
Resolution of compensatory pulmonary edema and heart arrhythmias Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility Infusion of normal saline of Ringer lactate to maintain the vascular space
Administration of oxygen and epinephrine to promote perfusion Question 18.18. A 66-year-old obese man with a diagnosis of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? (Points : 0.4)
His resting blood pressure is normally in the range of 150/90 and an echocardiogram indicates his ejection fraction is 30%. His end-diastolic volume is higher than normal and his resting heart rate is regular and 82 beats per minute. He is presently volume overloaded following several days of intravenous fluid replacement. Ventricular dilation and wall tension are significantly lower than normal. Question 19.19. A 68-year-old male complains to his nurse practitioner that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times, he feels that his heart is racing, and it also seems to pause at times. The man has also occasionally had lightheadedness and a recent syncopal episode. What is this patient’s most likely diagnosis and the phenomenon underlying it? (Points : 0.4)
Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias Ventricular arrhythmia as a result of alternating vagal and sympathetic stimulation
Torsades de pointes as a result of disease of the bundle of His Premature atrial contractions that vacillate between tachycardic and bradycardic episodes as a consequence of an infectious process Question 20.20. An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist’s report is most suggestive of a possible history of poorly controlled blood pressure? (Points : 0.4)
“Scarring of urethra suggestive of recurrent urinary tract infections is evident.” “Bilateral renal hypertrophy noted.” “Vessel wall changes suggestive of venous stasis are evident.” “Arterial sclerosis of subcortical brain regions noted.” Question 21.21. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms.Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 0.4)
Aneurysms are commonly a result of poorly controlled diabetes mellitus. Hypertension is a frequent modifiable contributor to aneurysms. Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.
Aneurysms can normally be resolved with lifestyle and diet modifications. Question 22.22. A patient has suffered damage to his pericardium following a motor vehicle accident. Which of the following consequences should the nurse practitioner be most likely to rule out? (Points : 0.4)
Impaired physical restraint of the left ventricule Increased friction during the contraction/relaxation cycle Reduced protection from infectious organisms Impaired regulation of myocardial contraction Question 23.23. A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? (Points : 0.4)
“Remember, the ‘H’ in HDL and the ‘L’ in LDL correspond to high danger and low danger to your health.” “Having high cholesterol increases your risk of developing diabetes and irregular heart rate.” “Smoking and being overweight increases your risk of primary hypercholesterolemia.” “Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk.”
Question 24.24. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)
An increase in preload via the Frank-Starling mechanism Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP) AV node pacemaking activity and vagal nerve suppression Question 25.25. A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his nurse practitioner. Which of the following aspects of hyperlipidemia would the nurse practitioner most likely take into account when teaching the patient? (Points: 0.4)
Hyperlipidemia is a consequence of diet and lifestyle rather than genetics. HDL cholesterol is often characterized as being beneficial to health. Cholesterol is a metabolic waste product that the liver is responsible for clearing. The goal of medical treatment is to eliminate cholesterol from the vascular system.
1. A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by the student would warrant correction by the nurse practitioner? (Points : 0.4)
“As vessel wall thickness increases, tension decreases.” “Smaller blood vessels require more pressure to overcome wall tension.” “The smaller the vessel radius, the greater the pressure needed to keep it open.” “Tension and vessel thickness increase proportionately.” Question 2.2. A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations.A resting electrocardiogram reveals sinus bradycardia and she is suspected of having sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? (Points: 0.4)
Signal-averaged ECG Exercise stress testing Electrophysiologic study Holter monitoring Question 3.3. Which of the following assessment findings in a newly admitted 30-year-old male patient would be most likely to cause his nurse practitioner to suspect polyarteritis nodosa? (Points : 0.4)
The man’s blood work indicates polycythemia (elevated red cells levels) and leukocytosis (elevated white cells). The man’s blood pressure is 178/102 and he has abnormal liver function tests. The man is acutely short of breath and his oxygen saturation is 87%. The man’s temperature is 101.9°F and he is diaphoretic (heavily sweating). Question 4.4. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)
An increase in preload via the Frank-Starling mechanism Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP) AV node pacemaking activity and vagal nerve suppression Question 5.5. A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? (Points : 0.4)
“Remember, the ‘H’ in HDL and the ‘L’ in LDL correspond to high danger and low danger to your health.” “Having high cholesterol increases your risk of developing diabetes and irregular heart rate.” “Smoking and being overweight increases your risk of primary hypercholesterolemia.” “Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk.” Question 6.6. A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his nurse practitioner. Which of the following aspects of hyperlipidemia would the nurse practitioner most likely take into account when teaching the patient? (Points : 0.4)
Hyperlipidemia is a consequence of diet and lifestyle rather than genetics. HDL cholesterol is often characterized as being beneficial to health. Cholesterol is a metabolic waste product that the liver is responsible for clearing. The goal of medical treatment is to eliminate cholesterol from the vascular system. Question 7.7. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)
A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest Question 8.8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 0.4)
Hypovolemic shock Septic shock Neurogenic shock Obstructive shock Question 9.9. A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks’ gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her? (Points : 0.4)
Plasma angiotensin I and II and renin Urinary sodium and potassium Platelet count, serum creatinine, and liver enzymes Urinary catecholamines and metabolites Question 10.10. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0.4)
BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology. BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure. BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia. BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects. Question 11.11. A nurse practitioner has ordered the measurement of a cardiac patient’s electrolyte levels as part of the patient’s morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient’s heart? (Points : 0.4)
Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation. Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells. The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions. The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential. Question 12.12. A 70-year-old male patient presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. What would his care provider’s preliminary diagnosis and anticipated treatment most likely be? (Points : 0.4)
Acute arterial occlusion that will be treated with angioplasty Raynaud disease that will require antiplatelet medications Atherosclerotic occlusive disease necessitating thrombolytic therapy Giant cell temporal arteritis that will be treated with corticosteroids Question 13.13. Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? (Points : 0.4)
Pressure in the pulmonary circulation and the right side of the infant’s heart fall markedly. Alveolar oxygen tension increases, causing reversal of pulmonary vasoconstriction of the fetal arteries. Systemic vascular resistance and left ventricular pressure are both increasing. Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant’s first week. Question 14.14. In which of the following patient situations would a nurse practitioner be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient’s health problems? (Points : 0.4)
A 61-year-old man whose ECG was characterized by widespread T wave inversions on admission but whose T waves have recently normalized A 77-year-old with diminished S3 and S4 sounds, an irregular heart rate, and a history of atrial fibrillation A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels Question 15.15. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is
explaining the diagnosis to the patient, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 0.4)
Aneurysms are commonly a result of poorly controlled diabetes mellitus. Hypertension is a frequent modifiable contributor to aneurysms. Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures. Aneurysms can normally be resolved with lifestyle and diet modifications. Question 16.16. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)
Increased preload due to vascular resistance High afterload because of backpressure against the left ventricle Impaired contractility due to aortic resistance Systolic impairment because of arterial stenosis Question 17.17. A 66-year-old patient’s echocardiogram reveals a hypertrophied left ventricle, normal chamber volume, and a normal ejection fraction from the heart. What is this patient’s most likely diagnosis? (Points : 0.4)
Mitral valve regurgitation Aortic valve stenosis Mitral valve stenosis Aortic valve regurgitation Question 18.18. A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect? (Points : 0.4)
Pheochromocytoma Essential hypertension Coarctation of the aorta An adrenocortical disorder Question 19.19. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours.Which of the following statements best captures an aspect of Holter monitoring? (Points: 0.4)
A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity.
The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies. Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording. Holter monitors are normally set to record electrical activity of the heart at least once per hour. Question 20.20. An 81-year-old female patient of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the patient has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the patient’s condition? (Points : 0.4)
Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest. Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. Peripheral dilation is associated with decreased stroke volume and ejection fraction. Heart valves are not capable of preventing backflow in cases of atrial congestion. Question 21.21. As part of the diagnostic workup for a male patient with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements, and
imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? (Points : 0.4)
Echocardiogram, PET scan, ECG Ambulatory ECG, cardiac MRI, echocardiogram Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy Cardiac catheterization, cardiac CT, exercise stress testing Question 22.22. A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was “so fast I couldn’t even count it.” The child was determined to be in atrial flutter and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother? (Points: 0.4)
The child is experiencing a reentry rhythm in his right atrium. The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions. The child is likely to have a normal ECG apart from the rapid heart rate. The boy’s atria are experiencing abnormal sympathetic stimulation. Question 23.23. A 66-year-old obese man with a diagnosis of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? (Points : 0.4)
His resting blood pressure is normally in the range of 150/90 and an echocardiogram indicates his ejection fraction is 30%. His end-diastolic volume is higher than normal and his resting heart rate is regular and 82 beats per minute. He is presently volume overloaded following several days of intravenous fluid replacement. Ventricular dilation and wall tension are significantly lower than normal. Question 24.24. A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his nurse practitioner. The patient’s nurse practitioner would anticipate that which of the following phenomena is most likely occurring? (Points : 0.4)
The patient’s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation. Epinephrine from his adrenal gland is initiating the renin-angiotensinaldosterone system. Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction. The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption. Question 25.25. The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following
teaching points best conveys an aspect of the human circulatory system? (Points : 0.4)
“Your blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation.” “Only around one quarter of your blood is in your heart at any given time.” “Blood pressure and blood volume roughly mimic one another at any given location in the circulatory system.” “Left-sided and right-sided pumping action at each beat of the heart must equal each other to ensure adequate blood distribution.” Winland-Brown, J.E. and Dunphy, L.M. (2013). Adult-Gerontology and Family Nurse Practitioner Certification Examination: Review Questions and Strategies. Codina Leik, M.T. (2013). Adult-Gerotonolgy Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions. 2ND Ed.
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NR 507 Week 4 Discussions Alterations in Renal Function
For more course tutorials visit uophelp.com is now newtonhelp.com www.newtonhelp.com Week 4: Alterations in Renal Function
Discussion Part One
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1)
Mrs. Orndorf is a 28-year-old woman married for 3 years who has just returned from an outdoor camping trip with her husband, with symptoms of dysuria with a burning sensation, urgency to urinate, and frequent urination. She said, “I have had similar symptoms three times over the last 2 years. Pubic and low back discomfort awoke me two nights ago and that is why I am here.” On physical examination, her temperature was 98.6° F, blood pressure was 114/64 mm Hg, pulse was 68 beats per minute, and the respiratory rate was 12 breaths per minute. Other than a tender abdominal pelvic area, the examination was unremarkable.
• What is your list of differential diagnoses in this case and explain how each of these fits with the case patient as described above. Be sure to list at least four (4) pertinent differential diagnoses. Indicate which of these you would select as the most likely diagnosis and explain why.
• According to the first item in your differential, what are the risk factors for this disorder?
• What are some treatments for this disorder?
Discussion Part Two
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
A 56-year-old female comes into the clinic complaining of intermittent severe pain that radiates from the flank to the groin and sometimes to the inner thigh. Upon further questioning she tell you that she has an urge to always go to the restroom and that she sometime sweats and feels nauseous. A urinalysis provides traces of blood, a few white blood cells and no bacteria.
• What is your differential diagnosis? Discuss in detail the pathophysiology of each item in your differential and how it might fit in describing this case.
• The x-ray comes back and there is nothing abnormal except a slightly dilated ureter. Does this change your differential or narrow it?
• How would you treat the pain in this case?
Discussion Part Three
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
A 60-year-old patient comes into your office with a history of hypertension and a myocardial infarction 13 years ago. You notice that both of her ankles are swollen and that her skin seems shiny. She first noticed her ankle swelling 9 months ago and it has gotten progressively worse. She has a smell of ammonia on her. She also has a 2 year history of diabetes.
• What are at least five systemic effects of chronic kidney disease?
• How would you modify the diet and what is the rationale to the changes of the diet that you make?
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NR 507 Week 5 Discussions Alterations in Endocrine Function
For more course tutorials visit uophelp.com is now newtonhelp.com
www.newtonhelp.com Week 5: Alterations in Endocrine Function
Discussion Part One
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. She has a history of Type I diabetes. On admission her laboratory values show:
Sodium (Na+) 156 mEq/L
Potassium (K+) 4.0 mEq/L
Chloride (Cl–) 115 mEq/L
Arterial blood gases (ABGs) pH- 7.30; Pco2-40; Po2-70; HCO3-20
Normal values Sodium (Na+) 136-146 mEq/L
Potassium (K+) 3.5-5.1 mEq/L
Chloride (Cl–) 98-106 mEq/L
Arterial blood gases (ABGs) pH- 7.35-7.45
Pco2- 35-45 mmHg
Po2-80-100 mmHg
HCO3–22-28 mEq/L
• List five (5) reasons on why she may have become bed ridden?
• Based on these reasons what tests would you order?
• Describe the molecular mechanism of the development of ketoacidosis.
Discussion Part Two
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states
A three-month-old baby boy comes into your clinic with the main complaint that he frequently vomits after eating. He often has a swollen upper belly after feeding and acts fussy all the time. The vomiting has become more frequent this past week and he is beginning to lose weight.
• What is your differential diagnosis at this time?
• Is there any genetic component to the top of your differential?
• What tests would you order?
Discussion Part Three
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
Write a one (1) paragraph case study of your own for a patient with Ulcerative Colitis?
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NR 507 Week 6 Discussions Dermatologic and Musculoskeletal Disorders
For more course tutorials visit uophelp.com is now newtonhelp.com www.newtonhelp.com Week 6: Dermatologic and Musculoskeletal Disorders
Discussion Part One
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states
You are contacted by an attorney representing a client who has been charged with child abuse and whom faces loss of her child and 15 years in prison. The record indicated that the child was 4 years old and presented to the ER room with a broken arm and a broken leg There also appeared to be multiple previous fractures. Now, you examine the child and find blue sclera, a sunken chest wall, severe scoliosis, and you observe a triangular face and prominent forehead. You confirm that there have been multiple previous fractures by evaluating the previous X-rays. This is a genetic disorder.
• What is the most likely genetic disease that this presents and why?
• What is the molecular basis of this disease?
• Before, calling the police what should the initial clinician have done?
Discussion Part Two
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1)
Johnny is a 5-year-old Asian boy who is brought to a family practice office with a “runny” nose that started about 1 week ago but has not resolved. He has been blowing his nose quite frequently and “sores” have developed around his nose. His mother states, “The sores started as ‘big blisters’ that rupture; sometimes, a scab forms with a crust that looks like “dried maple syrup” but continues to seep and drain.” She is worried because the lesions are now also on his forearm. Johnny’s past medical and family histories are normal. He has been febrile but is otherwise asymptomatic. The physical examination was unremarkable except for moderate, purulent rhinorrhea and 0.5- to 1-cm diameter weeping lesions around the nose and mouth and on the radial surface of the right forearm. There is no regional lymphadenopathy.
• Write a differential of at least five (5) possible diagnosis’s and explain how each may be a possible answer to the clinical presentation above. Remember, to list the differential in the order of most likely to less likely.
• Based upon what you have at the top of the differential how would you treat this patient? Differential diagnosis for this clinical presentation and justify it.
• When would you allow the student back to school? Elaborate on your reasoning?
Discussion Part Three
Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and a fever of about 104 0C, She also has a rash on her face a possibly the beginning of a rash on her arms. About 10 days ago she was around another student who had similar symptoms.
• What is the differential diagnosis?
• What are some of the complications of this disease, assume that the top of your differential is the definitive?
• Assume that the second item you place on your differential is the definitive diagnosis. What are some complications of that disease?
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NR 507 Week 7 Discussions Behavioral, Neurologic, and Digestive Disorders
For more course tutorials visit uophelp.com is now newtonhelp.com www.newtonhelp.com Week 7: Behavioral, Neurologic, and Digestive Disorders
Discussion Part One
This week’s graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
You are at the local mall and you see a patient who appears to be homeless by his physical appearance and you witness the person “walk 50 feet to a table sit down, and after 5 seconds he gets up and walks to a tree and urinates on it� He repeats this action 5 times apparently oblivious to his surroundings. When the police come he ignores them as if they aren’t there. Later, you go to work and sitting in exam room 3 is
the same person! Now, he is your patient, when you talk to him he has no recollection of his behavior by the mall.
• What is your differential diagnosis?
• What tests do you order?
• An MRI comes back and there seems to be a lesion in the temporal lobe does this change your differential? The EEG also comes back with unusual excitatory activity. What is your definitive diagnosis? In retrospect did anything bias your first differential?
Discussion Part Two
Your patient is a 77-year-old woman who has been more socially withdrawn lately and told her daughter she had not been feeling well. Her daughter has noticed a stepwise decline. While shopping for groceries with her daughter she became separated from daughter in the aisles. She became confused and angry when store employees and others tried to assist her. Her current medications are Hydrochlorothiazide, Lisinopril and Atorvastatin.
• What is your differential diagnosis based on the information you now have?
• What other questions would you like to ask her now? (Questions can be asked of patient first, and then of reliable historian separately.)
• How would you treat this patient and discuss why you give each medication or therapy you give.
Discussion Part Three
1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)
A 19-year-old freshman in college has been brought to your office by campus security. The patient had been standing on top of the school chapel proclaiming that he was the prophet of God and that God was speaking to him. In fact he claimed to actually hear God’s voice. When he is in your office you notice that he is speaking very fast, can’t seem to sit still and his sentences at times don’t seem to make sense. He states, “I saw the professor sit on the ham sandwich and eat the raw calculus in his mind”
• What is your differential diagnosis, how does it fit how might it not fit?
• Based on the top of your differential what is the epidemiology of that disorder?
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NR 507 Week 8 Discussions Genomes, Genetic Alterations, and Reproductive Disorders Reflection
For more course tutorials visit uophelp.com is now newtonhelp.com www.newtonhelp.com Week 8: Genomes, Genetic Alterations, and Reproductive Disorders Reflection
Reflect on personal and professional growth toward achieving competence as a family nurse practitioner. (PO 5, 10)
Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #, MSN Essential VIII, and Nurse Practitioner Core Competencies # 1 Scientific Foundation Competencies
Program Outcome #4: Evaluate the design, implementation, and outcomes of strategies developed to meet healthcare needs (MSN Essentials III, IV, VIII). MSN Essential VIII: Clinical Prevention and Population Health for Improving Health
•Recognizes that the master’s-prepared nurse applies and integrates broad, organizational, client-centered, and culturally appropriate concepts in the planning, delivery, management, and evaluation of evidence-based clinical prevention and population care and services to individuals, families, and aggregates/identified populations.
Nurse Practitioner Core Competencies # 1 Scientific Foundation Competencies
1. Critically analyzes data and evidence for improving advanced nursing practice.
2. Integrates knowledge from the humanities and sciences within the context of nursing science.
3. Translates research and other forms of knowledge to improve practice processes and outcomes.
4. Develops new practice approaches based on the integration of research, theory, and practice knowledge.
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