Question 1

A 40-year-old female presents complaining of pain near the midline in the epigastrium. Assuming the pain is caused by a stimulus acting on an abdominal organ, the pain felt is classified as:

a. Visceral

b. Somatic

c. Parietal

d. Referred

Question 2

An 8-week-old male was recently diagnosed with cystic fibrosis. Which of the following digestive alterations would be expected?

a. Insufficient bile production

b. Gastric atrophy

c. Hypersecretion of stomach acid

d. Nutrient malabsorption

Question 3

In alcoholic cirrhosis, hepatocellular damage is caused by:

a. acetaldehyde accumulation.

b. bile toxicity.

c. acidosis.

d. fatty infiltrations.

Question 4

Where does the nurse expect the obstruction to be in a patient with extrahepatic portal hypertension?

a. Sinusoids

b. Bile ducts

c. Hepatic portal vein

d. Hepatic artery

Question 5

Kwashiorkor is a severe dietary deficiency of:

a. fat-soluble vitamins.

b. carbohydrates.

c. protein.

d. calcium and magnesium.

Question 6

A 27-year-old male presents with fever, GI bleeding, hepatomegaly, and transient joint pain. He reports that as a child he received blood transfusions following a motor vehicle accident. He also indicates he was vaccinated against hepatitis B. Which of the following types of hepatitis does the clinician think he most likely has?

a. A

b. B

c. C

d. D

Question 7

Prolonged diarrhea is more serious in children than adults because:

a. children have lower adipose reserves.

b. fluid reserves are lower in children.

c. children have a lower metabolic rate.

d. children are more resistant to antimicrobial therapy.

Question 8

A 40-year-old male develops an intestinal obstruction related to protrusion of the intestine through the inguinal ring. This condition is referred to as:

a. Intussusception

b. A volvulus

c. A hernia

d. Adhesions

Question 9

A 60-year-old male presents with GI bleeding and abdominal pain. He reports that he takes NSAIDs daily to prevent heart attack. Tests reveal that he has a peptic ulcer. The most likely cause of this disease is:

a. Increasing subepithelial bicarbonate production

b. Accelerating the H+ (proton) pump in parietal cells

c. Inhibiting mucosal prostaglandin synthesis

d. Stimulating a shunt of mucosal blood flow

Question 10

Acute pancreatitis often manifests with pain to which of the following regions?

a. Right lower quadrant

b. Right upper quadrant

c. Epigastric

d. Suprapubic

Question 11

A 60-year-old male is diagnosed with cancer of the esophagus. Which of the following factors most likely contributed to his disease?

a. Reflux esophagitis

b. Intestinal parasites

c. Ingestion of salty foods

d. Frequent use of antacids

Question 12

The primary complication of enterocolitis associated with Hirschsprung disease is related to which finding?

a. Fecal impaction

b. Pancreatic insufficiency

c. Hyperactive peristalsis

d. Ileal atresia

Question 13

The most common cause of chronic vascular insufficiency among the elderly is:

a. Anemia

b. Aneurysm

c. Lack of nutrition in gut lumen

d. Atherosclerosis

Question 14

The most common clinical manifestation of portal hypertension is _ bleeding.

a. rectal

b. duodenal

c. esophageal

d. intestinal

Question 15

A 54-year-old male is diagnosed with peptic ulcer disease.This condition is most likely caused by:

a. Hereditary hormonal imbalances with high gastrin levels

b. Breaks in the mucosa and presence of corrosive secretions

c. Decreased vagal activity and vascular engorgement

d. Gastric erosions related to high ammonia levels and bile reflux

Question 16

The cardinal sign of pyloric stenosis caused by ulceration or tumors is:

a. Constipation

b. Diarrhea

c. Vomiting

d. Heartburn

Question 17

A 55-year-old male died in a motor vehicle accident. Autopsy revealed an enlarged liver caused by fatty infiltration, testicular atrophy, and mild jaundice secondary to cirrhosis. The most likely cause of his condition is:

a. Bacterial infection

b. Viral infection

c. Alcoholism

d. Drug overdose

Question 18

Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of:

a. hyperbilirubinemia and jaundice.

b. fluid and electrolyte imbalances.

c. impaired ammonia metabolism.

d. decreased cerebral blood flow.

Question 19

The most common disorder associated with upper GI bleeding is:

a. diverticulosis.

b. hemorrhoids.

c. esophageal varices.

d. cancer.

Question 20

A 3-month-old female develops colicky pain, abdominal distention, and diarrhea after drinking cow’s milk. The best explanation for her symptoms is:

a. Deficiency of bile that stimulates digestive secretions and bowel motility

b. Excess of amylase, which increases the breakdown of starch and causes an osmotic diarrhea

c. Overgrowth of bacteria from undigested fat molecules, which leads to gas formation and de creased bowel motility

d. Excess of undigested lactose in her digestive tract, resulting in increased fluid movement into the digestive lumen and increased bowel motility

Question 21

A 55-year-old female has general symptoms of gallstones but is also jaundiced. IV cholangiography would most likely reveal that the gallstones are obstructing the:

a. Intrahepatic bile canaliculi

b. Gallbladder

c. Cystic duct

d. Common bile duct

Question 22

A 1-week-old female is brought to her pediatrician for abdominal distention and unstable temperature. Physical examination reveals bradycardia and apnea. Tests reveal hypoxic injury to the bowel resulting in bacterial invasion and perforation. This condition is referred to as:

a. Infective enteropathy

b. Necrotizing enterocolitis (NEC)

c. Mucoviscidosis

d. Ileus

Question 23

For the patient experiencing esophageal reflux, the nurse would expect which sphincter to be malfunctioning?

a. Pyloric

b. Lower esophageal

c. Upper esophageal

d. Gastric

Question 24

Cholecystitis is inflammation of the gallbladder wall usually caused by:

a. accumulation of bile in the hepatic duct.

b. obstruction of the cystic duct by a gall-stone.

c. accumulation of fat in the wall of the gallbladder.

d. viral infection of the gallbladder.

Question 25

A 6-month-old male infant is brought to the ER after the sudden development of abdominal pain, irritability, and vomiting followed by passing of “currant jelly” stool. Ultrasound reveals intestinal obstruction in which the ileum collapsed through the ileocecal valve and invaginated into the large intestine. This type of obstruction is referred to as:

a. Prolapse

b. Pyloric stenosis

c. Intussusception

d. Imperforation

Question 26

A 22-year-old male underwent brain surgery to remove a tumor. Following surgery, he experienced a peptic ulcer. His ulcer is referred to as a(n) _ ulcer.

a. Infectious

b. Cushing

c. Ischemic

d. Curling

Question 27

Chronic gastritis is classified according to the:

a. severity.

b. location of lesions.

c. patient’s age.

d. signs and symptoms.

Question 28

Reflux esophagitis is defined as a(n):

a. Immune response to gastroesophageal reflux

b. Inflammatory response to gastroesophageal reflux

c. Congenital anomaly

d. Secretory response to hiatal hernia

Question 29

The cardinal signs of small bowel obstruction are:

a. Vomiting and distention

b. Diarrhea and excessive thirst

c. Dehydration and epigastric pain

d. Abdominal pain and rectal bleeding

Question 30

The nurse assessing the patient with biliary atresia would expect to find which primary clinical manifestation?

a. Anemia

b. Jaundice

c. Hypobilirubinemia

d. Ascites

Question 31

A 20-year-old male was recently diagnosed with lactose intolerance. He eats an ice cream cone and develops diarrhea. His diarrhea can be classified as _ diarrhea.

a. Motility

b. Hypotonic

c. Secretory

d. Osmotic

Question 32

Which of the following symptoms would help a health care provider distinguish between ulcerative colitis and Crohn disease?

a. Pattern of remission/exacerbations

b. Abdominal pain

c. Malabsorption

d. Diarrhea

Question 33

A 45-year-old male complains of heartburn after eating and difficulty swallowing. He probably has:

a. Pyloric stenosis

b. Hiatal hernia

c. Gastric cancer

d. Achalasia

Question 34

The exocrine portion of the pancreas contains:

a. alpha cells.

b. beta cells.

c. acinar cells.

d. islets of Langerhans.

Question 35

Outbreaks of hepatitis _ often occur in young children attending day care centers and can be attributed to poor hand washing.

a. A

b. B

c. C

d. D

The Collaborative Learning Community: EBP Identification of Clinical Question assignment is due.

Prepare for your upcoming Topic 5 assignment, Collaborative Learning Community: EBP Literature Search/Appraisal of Evidence. Remember to record all communication in the CLC Forum.

Use the evidence hierarchy pyramid provided in Figure 2.1 in the Nursing Research: Generating and Assessing Evidence for Nursing Practice textbook as a guide for the levels of evidence in your reference list.

Locate case studies, relevant clinical articles written by experts, research articles, evidence-based guidelines, protocols, and theories that may guide the identification of appropriate solutions. This can include the articles reviewed in Topic 3. Note: Not all theories will have research that allows them to have a level assigned to them. This does not mean they are not good theories. A true proposal would require a comprehensive review of the literature and inclusion of all relevant works.

Appraise the evidence using the guidelines provided in the Nursing Research: Generating and Assessing Evidence for Nursing Practice textbook. Use these guidelines to discard references that are untrustworthy or irrelevant. Box 2.2 can help with this decision-making process. Chapter 5 provides guidance on how to synthesize the article findings.

Use the assigned Topic Material, “CLC EBP Research Table,” to consolidate and present the findings. Limit the articles to no more than 10 (two per student in the CLC group would be reasonable). Choose one group member to submit the completed assignment by the end of Topic 5.

Work Breakdown Structure (WBS)

Within reason, is there such a thing as a project that is too complex to complete? Consider the Space Shuttle. One of the most complex machines ever built, the Space Shuttle had over 2.5 million parts, each of which had to be accounted for by someone. How did anyone manage to track and properly assemble these parts? The answer is through the application of a work breakdown structure (WBS). A WBS is a fundamental tool that project managers use to organize and divide the work of a project. A WBS focuses on breaking down a project’s scope into individual deliverables that may be created by assigned team members.

There are multiple work breakdown structure formats and each has its own advantages and disadvantages. Project managers select a type of WBS based upon the specifics of the project they are managing. Each WBS format emphasizes different aspects of a project. These varied perspectives may each be appropriate, depending upon what information a project manager needs.

In this Discussion, you analyze different WBS formats and evaluate whether they meet basic criteria for clarity.

To prepare:

Explore the Work Breakdown Structure Formats document included in this week’s Learning Resources. The document presents a scenario and three corresponding WBS formats that pertain to the scenario. (SEE ATTACHED PDF FILE)
Consider the advantages and disadvantages of each WBS format included in the document.
Think about the level of detail dedicated to task information in each WBS format. Evaluate the formats based on the following criteria for clarity:

The task has a measurable status or completion.
The task has defined start and end events.
The task has a deliverable.
The task’s time and cost are easily estimated.
The task can be completed without interruption and additional input after its start.

Post by tomorrow 10/04/16 a minimum of 550 words essay in APA format with 3 references. Based on the Work Breakdown Structure Formats document attached in the file area, address the level one headings as numbered below:

1) An analysis of the advantages and disadvantages of each work breakdown structure format.

2) Provide an analysis of whether (and how) the work breakdown structures meet the assigned criteria for clarity.

3) Provide a rationale for your response.

Required Readings

Biafore, B. (2010). Microsoft Project 2010: The missing manual. Sebastopol, CA: O’Reilly.

Chapter 4, “Breaking Work Into Task-Sized Chunks” (pp. 77–100)

This chapter explains how to create a work breakdown structure and how to import a work breakdown structure into Microsoft Project.

Coplan, S., & Masuda, D. (2011). Project management for healthcare information technology. New York, NY: McGraw-Hill.

Chapter 3, “Project Management”

“Prepare Work Breakdown Structure and WBS Dictionary” (pp. 53–56)

This section of Chapter 3 reviews the core processes of preparing a work breakdown structure (WBS). The chapter provides an example of a WBS and details its essential components.

Project Management Institute. (2013). A guide to the project management body of knowledge (PMBOK guide) (5th ed.). Newtown Square, PA: Author.

Chapter 5, “Project Scope Management”

5.3, “Create WBS” (pp. 125–132)

This section of Chapter 5 reviews the process of creating a work breakdown structure. Specifically, the chapter examines how to determine inputs, WBS tools and techniques, and outputs.

Kendrick, T. (2009). Identifying & managing project risk: Essential tools for failure-proofing your project(2nd ed., Ebrary version). New York, NY: AMACOM.

Retrieved from the Walden Library databases.

Chapter 3, “Identifying Project Scope Risk” (pp. 40–69)

This chapter examines methods of identifying scope risks and the types of scope risks pertaining to project deliverables. The chapter highlights a variety of sources of scope risk as well.

Shirey, M. R. (2008). Project management tools for leaders and entrepreneurs. Clinical Nurse Specialist, 22(3), 129–131.

Retrieved from the Walden Library databases.

The author of this article introduces project management tools that clinical nurse specialists may use to coordinate team work. The article highlights the usage of one such tool, the Gantt chart.

Thomas, M., Jacques, P. H., Adams, J. R., & Kihneman-Wooten, J. (2008). Developing an effective project: Planning and team building combined. Project Management Journal, 39(4), 105–113.

Retrieved from the Walden Library databases.

This article analyzes project planning and control and the process of developing a project plan. The article also reports the results of research that sought to determine 137 organizations’ approaches to establishing projects.

U.S. Government Accountability Office. (2009, March 2). Work breakdown structure. GAO Reports, 65–78.

Retrieved from the Walden Library databases.

This article examines the importance of a work breakdown structure (WBS) in project management. The chapter demonstrates how a WBS assists in resource identification, cost estimation, and risk determination.

Wu, Z., Schmidt, L. P., & Wigstrom, M. S. (2010). Product development workflow management based on work breakdown structure. IIE Annual Conference. Proceedings, 1–5.

Retrieved from the Walden Library databases.

The authors of this article highlight the usage of WBS in managing complex product development projects. The authors examine how a WBS helps represent and manage the intricacies of tasks and activity relationships.

Mathis, M. (n.d.). Work breakdown structure: Purpose, process and pitfalls. Retrieved March 13, 2013, from http://www.projectsmart.co.uk/work-breakdown-structure-purpose-process-pitfalls.html

This article provides a general review of the WBS. The author focuses on the purpose, process, and pitfalls of a WBS.

Document: Work Breakdown Structure Formats (PDF) (See ATTACHED PDF IN FILE AREA)

This document presents a scenario and three corresponding work breakdown structures that you will use for your Discussion this week.

Required Media

Laureate Education (Producer). (2013c). Planning, part I: Defining project scope and activities [Video file]. Retrieved from https://class.waldenu.edu

Note: The approximate length of this media piece is 6 minutes.

In this presentation, the participants discuss defining project scope and project activities, using the work breakdown structure, and managing project risk through SWOT analysis.

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

1) After performing an emergency cesarean section, the physician noticed that the appendix was distended, resulting in medical necessity for an appendectomy performed during the same operative session.

2) The physician freed intestinal adhesions.

3) The physician resected two segments of small intestine and performed an anastomosis between the remaining intestinal ends. An open approach was used for this surgery.

4) The physician repaired a defect in the mesentery with sutures.

5) The physician performed a laparoscopic partial colectomy with end colostomy and closure of the distal segment.

6) The physician drained a pelvic abscess through the rectum.

7) The physician removed a portion of the rectum through combined abdominal and transsacral approaches.

8) The physician performed rigid proctosigmoidoscopy and obtained brushings.

9) The physician performed a flexible sigmoidoscopy and removed a polyp. The physician inserted the sigmoidoscope through the anus and advanced the scope into the sigmoid colon. The lumen of the sigmoid colon and rectum were well visualized, and the polyp was identified and removed with hot biopsy forceps. The sigmoidoscope was withdrawn upon completion of the procedure.

10) The physician inserted a colonscope through the anus and advanced the scope past the splenic flexure. Two polps were identified and removed by hot biopsy forceps.

1) Hepatotomy for open drainage of abscess or cyst, 1 stage.

2) Surgeon removed segments II, III, and IV (the whole left lobe) of the liver from a living donor.

3) The physician performed radiofrequency ablation of a liver tumor via open laparotomy.

4) The physician removed the gallbladder and performed a common bile duct exploration through the laparoscope.

5) The physician performed a cholecystostomy with removal of calculus.

6) Subsequent to previous peritoneocentesis (performed at a different operative session), the physician withdrew fluid and performed infusion and drainage of fluid from the abdominal cavity (peritoneal lavage).

7) The physician reopened a recent laparotomy incision, before the incision had fully healed, to drain a postoperative infection.

8) The physician performed laparoscopic repair of an initial inguinal hernia.

9) The physician performed a reducible ventral hernia (initial) repair and inserted mesh implantation.

10) The physician repaired an initial reducible, inguinal hernia with hydrocelectomy in a 5 month old infant.

1) Physician made an open incision and inserted multiple drain tubes to drain an infection (abscess) from the kidney.

2) The physician pulverized a kidney stone (renal calculus) by directing shock waves through a water cushion that was placed against the left side of the patient’s body at the location of the kidney stone.

3) The physician removed a kidney stone (calculus) by making an incision in the right kidney.

4) The interventional radiologist inserted a percutaneous nephrostomy catheter into the right renal pelvis for drainage. Fluoroscopic guidance was provided.

5) The physician performed a laparoscopic ablation of a solid mass from the posterior hilum of the left kidney.

6) The physician made an incision in the left ureter through the abdominal wall for examination of the ureter and insertion of a catheter for drainage.

7) The physician examined the patient’s right and left renal and ureteral structures with an endoscope, which passed through an established opening between the skin and the ureter (ureterostomy). He also inserted a catheter into the ureter.

8) The physician revised a surgical opening between the skin and the right ureter.

9) The physician injected contrast agent through an opening between the skin and the left ureter (ureterostomy) for ureterography (study of renal collecting system).

10) The physician made an incision in the left ureter (ureterotomy) to insert a catheter (stent) into the ureter.

11) The physician performed a transurethral resection of a postoperative bladder neck contracture using a resectoscope.

12) The physician inserted a special instrument through the cystourethroscope to fragment a calculus in the ureter using electrohydraulics.

13) The physician inserted a cystourethroscope through the urethra to drain an abscess on the prostate.

14) The physician made an incision through the abdominal wall into the urinary bladder and inserted a suprapubic catheter to withdraw urine.

15) The physician performed a cystourethroscopy with fulguration of the bladder neck and then removed a calculus from the ureter.

16) The physician performed a sling procedure using synthetic material to treat a male patient’s urinary incontinence.

17) The physician made an initial attempt to treat a male patient’s urethral stricture using a dilator.

18) The physician, in the first two stages to reconstruct the urethra identified the area of stricture by urethrography and marked it with ink.

19) The physician performed a transurethral destruction of the prostate using microwave therapy.

The physician excised a specimen of tis