1.   Anesthesia administered to a normal, healthy patient undergoing an esophageal procedure is coded as

   A. 00500-P1.   B. 00502-P1.   C. 00500-P2.   D. 00506-P1. 

2.   A new patient comes into the doctor’s office for her annual gynecological exam. During the course of the exam, she undergoes a screening cervical cytopathology smear, which is performed by an automated system under the supervision of a physician. What HCPCS code is assigned?

   A. G0185   B. G7869   C. G7452   D. G0147 

3.   A new patient is seen for a home visit that involves a comprehensive history, examination, and medical decision making of high complexity. What code should be assigned?

   A. 99349   B. 99345   C. 99342   D. 99350 

4.   A prolonged evaluation and management service before and/or after direct patient care for one hour is coded as

   A. 99359.   B. 99358.   C. 99361.   D. 99360. 

5.   A 57-year-old patient is admitted to the hospital for a hip arthroscopy procedure. The patient is a normal healthy patient with no systemic disease. What anesthesia CPT code should be assigned?

   A. 01242-P2   B. 01202-P1   C. 01202-P3   D. 01202-P5 

6.   Anesthesia for procedures performed on the larynx and trachea in an 11-month-old child would be assigned to code

   A. 00620.   B. 00625.   C. 00326.   D. 00532. 

7.   A patient returns for a follow-up office visit regarding the repair of her fractured knee. The office visit consists of a detailed history, detailed examination, and medical decision making of moderate complexity. What CPT code is assigned?

   A. 99213   B. 99212   C. 99211   D. 99214 

8.   Intramuscular nonhormonal antineoplastic chemotherapy administration would be assigned to code

   A. 96402.   B. 96405.   C. 96406.   D. 96401. 

9.   Home infusion with specialty drug administration during a 6-hour visit would be assigned what codes?

   A. 99606, 99607 ×3   B. 99601, 99602 ×4   C. 99604, 99605 ×2   D. 99603, 99604 ×2 

10.   A patient is seen for a psychiatric diagnostic evaluation. The physician obtains a complete history of the patient’s mental status and does a complete biological and psychosocial assessment along with a complete physical examination. The physician’s final diagnosis is recurrent episode of severe major depressive disorder, without any psychotic behavior involved. The patient also has a history of psychological trauma. What codes are assigned?

   A. F33.2, Z91.49   B. F33.1, Z91.47   C. F34.2, Z91.49   D. F36.2, Z91.46 

11.   A 17-year-old patient is diagnosed with a severe form of nutritional anemia. What ICD-10-CM code should be assigned?

   A. D45.9   B. D53.9   C. D74.9   D. D65.9 

12.   A 32-year-old patient receives anesthesia for spinal surgery. The anesthesia is complicated by utilization of controlled hypotension. What add-on anesthesia code would be assigned?

   A. 99174   B. 92117   C. 99100   D. 99135 

13.   Nursing facility discharge day management of 19.5 minutes would be assigned to code

   A. 99317.   B. 99319.   C. 99316.   D. 99315. 

14.   A patient is admitted to the hospital for leukemia. She has a comprehensive history, comprehensive examination, and medical decision making of high complexity. What CPT code should be assigned?

   A. 99202   B. 99223   C. 99213   D. 99251 

15.   A service that is rarely provided, unusual, variable, or new may require a

   A. physician’s authorization.   B. patient’s authorization.   C. staged or related procedure.   D. special report. 

16.   A new patient is seen for a prescription refill. During the visit, the physician obtains a problem focused history, problem focused examination, and medical decision making is straightforward. What CPT code should be assigned for this service?

   A. 99214   B. 99215   C. 99213   D. 99201 

17.   A 7-year-old child is brought to the clinic due to recurrent ear infections. The physician performs a bilateral tympanostomy under general anesthesia. What CPT code should be assigned?

   A. 69436-50   B. 69536-50   C. 69426-50   D. 69736-50 

18.   Code 00906 is assigned for

   A. an angioscopy.   B. anesthesia for surgery performed on the bony pelvis.   C. an osteotomy.   D. anesthesia provided for a vulvectomy. 

19.   A 25-year-old patient receives a Hepatitis A vaccination. The vaccine is administered intramuscularly in the clinic. What CPT codes should be assigned?

   A. 90632, 90471   B. 90541, 90489   C. 90637, 90472   D. 90672, 90451 

20.   A dark adaptation examination with interpretation and report is assigned to code

   A. 92326.   B. 92284.   C. 92287.   D. 92325. 

1)     Assign CPT code(s) and appropriate modifiers to each statement.

The physician performed a complex repair during resection of the diaphragm and closed the residual defect with synthetic graft material.

2)      Mediastinotomy to remove foreign body using transthoracic approach, including median sternotomy.

3)      Patient underwent repair, laceration of diaphragm.

4)      Physician inserted a mediastinoscope through an incision in the sternal notch and performed a mediastinal lymph node biopsy.

5)      Physician  repaired an acute traumatic diaphragmatic hernia. 

    Patient underwent alveoloplasty to remove sharp areas or undercuts of alveolar bone, one quadrant.

      Surgeon used a scalpel to slice off a cancerous portion of the vermillion border of the patient’s lip: mucosal advancement was performed after excision.

      Surgeon made an incision through submucosal tissue and removed a lesion in the vestibule of the mouth. Wound repair was not required.

      Patient underwent simple incision of the lingual frenum to free the tongue.

      Patient underwent incision in the parotid gland to remove calcified stone.

    Surgeon repaired a tear at the pharyngeal esophageal junction.

      Physician drained and abscess near the tonsil.

     Surgeon removed an 8 year old patient’s tonsils and adenoids.

      Physician controlled secondary oropharyngeal hemorrhaging, status post tonsillectomy, by using cellulose sponges that expanded when placed in the tonsillar cavity.

  Physician performed a tonsillectomy on a 12 year old male patient.

    Physician inserted a flexible esophagoscope into the esophagus and destroyed a lesion, using snare technique.

   Surgeon made an incision in the left posterior chest wall into the esophagus to remove a foreign body from the esophagus.

  Physician inserted a balloon endoscopically for tamponade of bleeding esophageal varices.

    Dr. Smith performed a partial cervical esophagectomy while Dr. Jones performed a jejunum transfer with microvascular anastomosis.

   The physyician passed an endoscope through the patient’s mouth and visualized the entire esophagus, stomach, duodenum, and jejunum. One lesion was removed using biopsy forceps. Another was remove using snare.

      Patient underwent incision of the pyloric muscle.

      The physician performed an open revision of a previously performed gastric restrictive procedure and reversed the previously partitioned stomach to restore normal gastrointestinal continuity.

    Using fluoroscopic guidance, the physician repositioned a gastric feeding tube through the duodenum.

   The physician performed a laparoscopic surgical gastric restrictive procedure with gastric bypass and roux-en-Y gastroenterostomy.

 The physician percutaneously place a gastrostomy tube into the stomach under fluoroscopic guidance including contrast injection(s), image documentation. 

Question 1 A 15-year-old boy is being carefully monitored for a skin infection and is being given ciprofloxacin. The nurse will observe for which of the following?

A) Arthropathy
B) Colitis
C) Hepatitis
D) Hypotension

Question 2 A patient has been admitted to the critical care unit of the hospital with bacterial septicemia that has failed to respond to initial antibiotic treatment. The patient’s most recent blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA) in the patient’s blood. The nurse will anticipate that this patient will likely require intravenous administration of what antibiotic?

A) Vancomycin
B) Penicillin G
C) Cefazolin
D) Doripenem (Doribax)

Question 3 Mr. Laird is a 49-year-old electrician who experienced severe burns on his trunk, arms, and hands in a workplace accident 2 weeks ago. Part of his current wound care regimen involves the daily application of silver sulfadiazine to his wounds.The nurses who are providing care for Mr. Laird in the burns and plastics unit of the hospital should perform what action when administering this medication?

A) Apply a layer of silver sulfadiazine that is sufficiently thick to make the wound bed invisible.
B) Cleanse the wound of debris prior to applying the silver sulfadiazine
C) Apply a thin layer of the drug to Mr. Laird’s wound beds using clean technique.
D) Perform thorough wound care immediately after the application of silver sulfadiazine

Question 4 A patient is prescribed ganciclovir to treat a CMV infection. An oral dosage is prescribed. To help increase bioavailability of the drug, the nurse will encourage the patient to take the medication

A) with high-fat meals
B) with orange juice
C) on an empty stomach
D) with high-protein meals

Question 5 A patient has endocarditis and is taking gentamicin. The nurse will be sure to monitor which of the following?

A) Potassium level
B) Creatinine clearance
C) Serum albumin level
D) Prothrombin time

Question 6 A 30-year-old woman who is in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye that is crusted with purulent exudate. The clinician suspects a bacterial, rather than viral, etiology. How will the patient’s pregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis?

A) Ciprofloxacin is safe to use in pregnancy and the patient may use to same dose and route as a nonpregnant patient
B) The use of ciprofloxacin is contraindicated in pregnancy
C) It is safe for the patient to use topical ciprofloxacin but the oral route is potential teratogenic
D) The patient will require a lower dose and longer course of ciprofloxacin than a nonpregnant, adult patient

Question 7 A nurse has questioned why a patient’s physician has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of a patient’s infection. Which of the following facts provides the best rationale for the use of narrow-spectrum antibiotics whenever possible?

A) Broad-spectrum antibiotics confound the results of subsequent culture and sensitivity testing.
B) Narrow-spectrum antibiotics normally require a shorter duration of treatment
C) The efficacy of most narrow-spectrum antibiotics has not been proven
D) The use of broad-spectrum antibiotics can create a risk for a superinfection

Question 8 A 72-year-old patient is prescribed ophthalmic ciprofloxacin for a bacterial infection in her right eye. The nurse will teach her to observe for which of the following adverse effects of the drug?

A) Lid margin crusting and pruritus
B) Cognitive changes
C) Nephrotoxicity and neurotoxicity
D) Tendon ruptures

Question 9 A patient has been prescribed oral tetracycline.The nurse will instruct the patient to take the drug

A) on an empty stomach 1 hour before or 2 hours after taking any meals or other drugs.
B) with a meal.
C) with milk or fruit juice.
D) at bedtime only.

Question 10 A 20-year-old female patient is receiving topical clindamycin for acne vulgaris. She develops a rash and urticaria along with severe itching where the medication is applied. The nurse will formulate which of the following nursing diagnoses for the patient?

A) Diarrhea
B) Risk for Injury related to allergic reactions
C) Imbalanced Nutrition: Less than Body Requirements
D) Risk of Injury related to blood dyscrasia

drug therapy, including INH and rifampin. A priority assessment by the nurse will be to monitor which combination of laboratory test results?

A) Serum alanine transaminase, aspartate transaminase, and bilirubin
B) Red blood count, white blood count, and differential
C) Thyroid-stimulating hormone, thyroxine, and triiodothyronine levels
D) Fasting blood sugar and 2-hour postprandial blood sugar

Question 12 An immunocompromised cancer patient has developed cryptococcal meningitis and been admitted to the intensive care unit for treatment with amphotericin B. How should the nurse most safely administer this drug?

A) Hang the drug by piggyback with lactated Ringer’s and infuse over several hours to minimize the risk of infusion reaction
B) Infuse the drug over 2 to 4 hours into a central line using an infusion pump
C) Flush the patient’s central line with normal saline and infuse the amphotericin B by intravenous push over 5 to 7 minutes.
D) Place the patient on a constant infusion of amphotericin B at a rate determined by the patient’s body weight.

Question 13 A nurse is aware that the concept of selective toxicity is foundational to antimicrobial therapy. Which of the following statements most accurately describes selective toxicity?

A) A drug harms microbes without harming human cells
B) A drug’s effect on microorganisms is proportionate to dose
C) Most microbes may be collected from a host and cultured on an alternative medium
D) A drug can be isolated and produced in a controlled manner in a laboratory setting

Question 14 An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with

A) ciprofloxacin
B) clindamycin
C) vancomycin
D) an antistaphylococcic penicillin

Question 15 Laboratory testing has confirmed that a patient has chloroquine-resistant malaria and the patient’s physician has prescribed quinine along with an adjunctive drug. The nurse should question the physician’s order if the patient has a history of

A) osteoporosis or low bone density
B) chronic obstructive pulmonary disease (COPD)
C) diabetes mellitus
D) cardiac arrhythmias

Question 16 A 46-year-old man is receiving a quinupristin/dalfopristin IV infusion for a life-threatening infection. Which of the following would be most important for the nurse to monitor?

A) Increased heart rate
B) Breathlessness
C) Infiltration, edema, or phlebitis at the infusion site
D) Nausea and vomiting

Question 17 A patient with AIDS has developed a number of secondary infections in recent weeks, including Kaposi’s sarcoma. As a result of this most recent diagnosis, his care team has opted to begin treatment with interferon alfa-2a. The nurse is aware that this drug will address the etiology of Kaposi sarcoma by

A) inhibiting tumor growth by enhancing inflammation
B) potentiating the effects of phagocytes and macrophages
C) causing mutations in the DNA of cancerous cells
D) increasing the production of B cells and T cells

Question 18 Sulconazole has been prescribed for a patient with tinea pedis. The nurse will instruct the patient to use the topical agent

A) once a day
B) twice a day
C) three times a day
D) as needed

Question 19 Which of the following is critical to helping prevent development of resistant strains of microbes in patients?

A) Limit the exposure of bacteria to an antimicrobial agent
B) Keep the antimicrobial drug dosage high
C) Maintain the optimum duration of the antimicrobial agent
D) Maintain the maximum safe frequency of antimicrobial drug ingestion

Question 20 Which of the following nursing actions is most important in achieving successful antimicrobial therapy with vancomycin?

A) Provide maximum physical comfort to the patient
B) Monitor serum drug level
C) Taper down the drug dosage gradually
D) Promote adequate intake of fluids and nutrients

Question 21 A patient is being treated for Mycoplasma pneumoniae pneumonia. She is allergic to penicillin and is being given azithromycin (Zithromax) in capsule form. The nurse will inform the patient that she will need to take the capsule

A) with food
B) on an empty stomach
C) with or without food
D) immediately after she eats

Question 22 A patient is taking rifampin (Rifadin) for active TB. When discussing this drug with the patient, the nurse should stress that

A) the drug usually causes cardiac arrhythmias
B) the drug frequently causes seizure activity
C) facial flushing may appear but will go away once therapy is concluded
D) body fluids such as urine, saliva, tears, and sputum may become discolored

Question 23 A nurse is explaining the use of acyclovir therapy to a 72-year-old man. Nephrotoxicity is discussed as a major adverse effect in older patients. To minimize the risk of the patient developing this adverse effect, the nurse will advise him to

A) take the tablets on an empty stomach
B) decrease the drug dosage if initial symptoms of nephrotoxicity appear
C) stay well hydrated by drinking at least eight 8-oz glasses of water daily
D) eat light meals every day

Question 24 A 9-year-old boy was bought to his primary care provider by his mother with signs and symptoms of hookworm infection and will be sent home with a prescription for mebendazole. When provided patient and family education, the nurse should teach the mother with which of the following measures to avoid reinfection following treatment?

A) The importance of vigilant hygiene for the boy and the other members of the family
B) The need for the boy to provide serial stool samples for 6 months following treatment
C) The need to supplement the anthelminthic drug with prophylactic antibiotics
D) The need to use prescription skin cleansers during treatment and for 6 weeks after

Question 25 A nurse is caring for a patient who is on amphotericin B. On morning rounds the patient reports weakness, numbness, and a tingling sensation in his feet. What would be a priority action by the nurse?

A) Encourage the patient to increase fluid intake
B) Use strict aseptic technique for drug administration
C) Keep the bed in a low position and the side rails up at all times
D) Reduce the drug dosage

Question 26 A nurse is providing education to a patient who is taking INH. The nurse will advise the patient to avoid which of the following foods?

A) Cheese, dairy products, and bananas
B) Potatoes and root vegetables
C) Citrus fruits
D) Chicken and fish

Question 27 A child is taking permethrin for head lice. The nurse will instruct her mother to

A) wash her hair daily with a good shampoo
B) increase her daily intake of milk
C) maximize the child’s fluid intake
D) stop using creams, ointments, and oils on the child’s skin and scalp.

Question 28 A patient is receiving cefazolin in combination with anticoagulants. To minimize the adverse effects during therapy, the nurse will

A) monitor the site of injection
B) monitor the patient for bleeding gums
C) continue therapy until 2 days after symptoms have resolved
D) administer the medication with small amounts of food and fluids

Question 29 Which of the following would a nurse assess for in a patient who is taking polymyxin B systemically?

A) Peripheral neuropathy
B) Nephrotoxicity and hepatotoxicity
C) Hyperkalemia and hyponatremia
D) Endocarditis and hypertension

Question 30 A 30-year-old African-American woman tested positive for TB and is prescribed isoniazid. The nurse will plan the patient’s care to include close monitoring of the drug therapy because

A) the process of drug elimination will be faster in this patient
B) the therapeutic effect of the drug may be too slow to be effective
C) the patient is at greater risk for high serum levels of the drug
D) the process of drug metabolism may be faster in this patient

Question 31 A patient is receiving long-term clindamycin therapy for a life-threatening infection. The nurse will begin by monitoring this drug therapy by obtaining

A) blood glucose levels daily for 1 week
B) establishing the patient’s auditory abilities
C) a baseline complete blood count
D) liver enzymes weekly until the drug therapy is completed

Question 32 A 45-year-old female patient is prescribed ciprofloxacin to treat a bronchial infection. A nursing assessment revealed that she started taking daily vitamin supplements about 2 years ago. To maximize the therapeutic effects of the ciprofloxacin therapy, the nurse should advise the patient to

A) take the vitamins at least 2 hours before or after taking ciprofloxacin
B) alternate the dosage of ciprofloxacin and vitamin supplements
C) reduce the dosage of vitamin supplements
D) reduce the dosage of vitamin supplements and double the dosage of ciprofloxacin

Question 33 A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug

A) with a sip of water 1 hour before mealtime
B) immediately before or with a meal
C) with a glass of water 1 hour before or 2 hours after a meal
D) intravenously with the assistance of a home health nurse

Question 34 A 15-year-old patient has meningitis caused by Haemophilus influenzae. She is being treated with chloramphenicol. The most important nursing action for this patient would be to monitor

A) blood sugar levels daily
B) liver enzymes monthly
C) plasma concentrations regularly
D) urine output daily

Question 35 A 49-year-old farmer who normally enjoys good health has become seriously ill in recent days and the results of an extensive diagnostic work up have resulted in a diagnosis of histoplasmosis. The patient has been admitted to the hospital and has begun treatment with amphotericin B. The nurse who is providing care for the patient should prioritize which of the following diagnostic results during his course of treatment?

A) Electrolytes, blood urea nitrogen, and creatinine
B) Hemoglobin, hematocrit, and red blood cells
C) PT, PTT, and platelets
D) C-reactive protein

IT IS A SOAP NOTE, PROFESSOR ONLY ACCEPTED CLASS RESOURCES.

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”
• HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
• PMH: Asthma
• Medications: Symbicort 160/4.5mcg
• Allergies: NKDA
• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia
• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney
• Diagnostics: HSV specimen obtained

Assessment:

• Chancre
• PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

To prepare:

With regard to the SOAP note case study provided:

• Review this week’s Learning Resources, and consider the insights they provide about the case study.
• Consider what history would be necessary to collect from the patient in the case study.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature. 

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or Why not?
• Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis? 
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature. 

CALSS RESOURCES

Learning Resources 

Note:To access this week’s required library resources, please click on the link to the Course Readings List, found in theCourse Materialssection of your Syllabus.

Required Readings

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 16, “Breasts and Axillae” (pp. 350-369)
This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

Chapter 18, “Female Genitalia” (pp. 416-465)
In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.

Chapter 19, “Male Genitalia” (pp. 466-484)
The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.

Chapter 20, “Anus, Rectum, and Prostate” (pp. 485-500)
This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 5, “Amenorrhea” (pp. 47-60)
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.

Chapter 6, “Breast Lumps and Nipple Discharge” (pp. 61-72)
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.

Chapter 7, “Breast Pain” (pp. 73-80)
Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.

Chapter 27, “Penile Discharge” (pp. 318-324)
The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.

Chapter 36, “Vaginal Bleeding” (pp. 419-433)
In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient, as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.

Chapter 37, “Vaginal Discharge and Itching” (pp. 434-445)
This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
Chapter 3, “Adult Preventative Care Visits” (“Gender Specific Screenings”; pp. 48–49)Note: Download the Physical Examination Objective Data Checklist to use as you complete the Head-to-Toe Physical Assessment Video assignment.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

This Physical Examination Objective Data Checklist was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015).

Cucci, E. Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706.

Sabbagh, C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045
Retrieved from the Walden Library Databases. 

Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.
Retrieved from the Walden Library databases.
This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

Centers for Disease Control and Prevention. (2012). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#

This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

University of Virginia. (n.d.). Introduction to radiology: An online interactive tutorial. Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html

This website provides an introduction to radiology and imaging. For this week, focus on genitourinary radiology, as well as the cross-sectional female pelvis and the cross-sectional male pelvis in abdominal radiology.

Required Media

Online media for Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)
Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions.

Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)
In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.

Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)
The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.

Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)