The Figment Of A Man Who Looked Upon The Lady

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Post a response to the following: Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady

Review this week’s Learning Resources and reflect on the insights they provide.
Go to the Stahl Online website and examine the case study you were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
Review the posttest for the case study.
Provide the case number in the subject line of the Discussion.
List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s sleep/wake therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.

Diseases, Illnesses And Dagnosis

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Question 1. Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. The appropriate antibiotic to prescribe would be:

Penicillin VK, since his rash does not sound like a serious rash

Amoxicillin

Cefadroxil (Duricef)

Erythromycin

Question 2. Tetracyclines are contraindicated in children younger than 8 years because of:

Risk of developing cartilage problems

Development of significant diarrhea

Risk of kernicterus

Adverse effects on bone growth

Question 3. Lisa is a healthy non-pregnant adult woman who recently had a UTI. She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The answer to give her would be:

“Sixteen ounces per day of cranberry juice cocktail will prevent UTIs.”

“100% cranberry juice or cranberry juice extract may decrease UTIs in some patients.”

“There is no evidence that cranberry juice helps prevent UTIs.”

“Cranberry juice only works to prevent UTIs in children.”

Question 4. Rose is a 3 year old with an upper respiratory infection (URI). Treatment for her URI would include:

Amoxicillin

Diphenhydramine

Pseudoephedrine

Nasal saline spray

Question 5. Patient education for a patient who is prescribed antibiotics for sinusitis includes:

Use of nasal saline washes

Use of inhaled corticosteroids

Avoiding the use of ibuprofen while ill

Use of laxatives to treat constipation

Question 6. Patients who should be cautious about using decongestants for an upper respiratory infection include:

School-age children

Patients with asthma

Patients with cardiac disease

Patients with allergies

Question 7. Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?

Encourage increased fluids and fiber

Assess for pseudomembranous colitis

Advise her to eat yogurt daily to help restore her gut bacteria

Start her on an antidiarrheal medication

Question 8. To prevent further development of antibacterial resistance it is recommended fluoroquinolones be reserved for treatment of:

Urinary tract infections in young women

Upper respiratory infections in adults

Skin and soft tissue infections in adults

Community-acquired pneumonia in patients with comorbidities

Question 9. Nicole is a 4-year-old female with a febrile urinary tract infection. She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be:

Azithromycin

Trimethoprim/sulfamethoxazole

Ceftriaxone

Ciprofloxacin

Question 10. Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be:

Azithromycin

Trimethoprim/sulfamethoxazole

Ceftriaxone

Levofloxacin

Interprofessional Practice

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This week your Discussion will focus on interprofessional practice. This Discussion is an opportunity for you to examine your perspective and experiences with interprofessional collaborative practice and to apply your knowledge to managing patient care.

To prepare:

Identify a professional nursing organization and review their position on interprofessional practice

Review the following case study:

Case Study:

Ms. Tuckerno has been diagnosed with multiple sclerosis (MS). The patient receives care at an internal medicine clinic. Her internist is not in the office today and she is being treated by the nurse practitioner. The patient is on two medications for her MS, three different blood pressure medications, one medication for thyroid disease, one diabetic pill daily, insulin injections twice a day, she uses medical cannabis, and uses eye drops for glaucoma. Upon assessing the patient, the nurse practitioner (NP) decides her treatment plan should be adjusted. The NP discontinues some of the patient’s meds and discontinues medical cannabis. She orders the patient to follow up in two weeks.

The patient returns and is seen by her internist. The internist speaks with the patient and reviews her medical chart. The internist states to the patient, “I am dissatisfied with the care you received from the nurse practitioner.” The internist places the patient back on originally prescribed medications and medical cannabis.

Post 2 pages on : An explanation of your understanding of interprofessional practice.

Also, explain the position on interprofessional practice for a professional nursing organization that you are a member of or of which you plan to become a member.

Then, explain what you think is the best collaborative approach to manage Ms. Tuckerno’s care.

References

Required Readings

Altman, S. H., Butler, A. S., Shern, L. (Eds.). (2015). Assessing Progress on the IOM Report The Future of Nursing. Washington, DC: The National Academies Press. Retrieved from http://www.nationalacademies.org/hmd/Reports/2015/Assessing-Progress-on-the-IOM-Report-The-Future-of-Nursing.aspx doi: 10.17226/21838

Bankston, K., & Glazer, G., (2013) Legislative: Interprofessional collaboration: What’s taking so long? OJIN: The Online Journal of Issues in Nursing, 19(1).

Buppert, C. (2015). Appendix 11-D: Sample Professional Services Agreement. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (417-422). Burlington, MA: Jones & Bartlett.

Buppert, C. (2015). Legal Scope of Nurse Practitioner Practice. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (37-78). Burlington, MA: Jones & Bartlett.

Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).

Note: Retrieved from the Walden Library databases.

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Collaboration. In Advanced Practice Nursing: An Integrative Approach (5th ed.) (299-327). St. Louis, MO: Elsevier Saunders.

Practice-Specific Concepts, And List Of Propositions/Assumption

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Report Issue
Two Practice-Specific Concepts: Identification, discussion, and documentation from the literature of your perspective on at least two other concepts specific to your own practice.
What philosophies and theories from the literature of nursing and other disciplines/domains are consistent with these concepts?

How are the concepts of transcultural nursing, the health promotion model, skill acquisition, role theory, and change theory specifically integrated into my philosophy and practice?

What research supports these theories and concepts?

This assignment is for this week<<<<<<<< then the next assignment will be connected to this one and has to be integrated as one essay at the end<<<<<<<<I am adjunting the first part of the essay completed that can serve as the beginning.

Format

Your project paper should be in Microsoft Word 2010. Follow the current APA style. Your paper should be double-spaced, Times New Roman, and in 12 pt. font.

Quality of essay criteria*

The essay enlisted two practice-specific concepts.
8
The essay included clinical examples for each of the chosen concepts.
8
The clinical examples illustrated the concepts in a manner, which further clarified the students’ use of the conceptual material.
8
The essay demonstrated consistency between concepts, assumptions, and clinical application.
8
The essay identified and discussed students’ perspective on two other concepts specific to their practice.
8
The essay included a numbered list of at least 5 propositions or assumptions.
8
The concepts were connected and integrated to reveal a meaningful sequence.
8

Quiz Test

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Question 1 A patient is interested in learning more about healing. About what types of healing would the nurse suggest the patient focus this study?

Select all that apply.

  1. Spiritual
  2. Inner
  3. Physical
  4. Deliverance

Question 2 A patient tells the nurse that she is a member of a religion where birth control is either permitted or up to the choice of the couple. Which religions have this belief regarding the use of birth control?

Select all that apply.

  1. Buddhist Church of America
  2. Judaism
  3. Hinduism
  4. Mennonite

Question 3 The family member of a patient with bipolar disorder is sitting quietly in the waiting room praying. To which saint would the family member most likely be praying for help with mental illness?

  1. St. Dymphna
  2. St. Odilia
  3. St. Lucy
  4. St. Peregrine

Question 4 For which health problems would physical healing be the most appropriate with which to treat?

  1. A disease is present
  2. Someone afflicted with a bodily and mental evil
  3. Spiritual distress from personal sin
  4. An emotional or mental illness

Question 5 A person has an illness of the spirit. What method of treatment will this person receive?

  1. Repentance
  2. Heal the memory
  3. Laying of hands
  4. Exorcism

Question 6 A patient is planning to participate in a physical healing session. What activities will occur during this session?

Select all that apply.

  1. Laying on hands
  2. Speaking in tongues
  3. Having blood drawn
  4. Releasing muscle tension through massage

Question 7 A patient approaching delivery of her first child tells the nurse that many things need to be done prior to delivery because she will not be permitted activity for 40 days after the birth. The nurse realizes that which countries of national origin practice a 40-day waiting period after the delivery of a baby?

Select all that apply.

  1. Bangladesh
  2. Cuba
  3. Ethiopia
  4. Jordan
  5. Thailand

Question 8 A patient is planning to see a spiritual healer that practices telotherapy. What is this type of healing?

  1. Spiritual HEALING
  2. A method that separates the physical from the spiritual
  3. The expression of divine intervention
  4. The optimal method for HEALING

Question 9 A patient with terminal cancer is planning a trip to Lourdes, France, the site of a revered Roman Catholic shrine. What is the significance of visiting this shrine?

  1. The hope for receiving a cure through a miracle
  2. The hope being able to live a long life
  3. Becoming more prosperous
  4. Gaining insight about the cause of disease

Question 10 The family of a terminally ill patient is sitting in the waiting room with their parish priest praying for the patient to receive the grace of a happy death. To which saint is the family most likely addressing their prayers?

  1. St. Dymphna
  2. St. Odilia
  3. St. Lucy
  4. St. Peregrine

Question 11 A patient with a severe illness is reading the Bible. Which section of the Bible would help the patient with healing illnesses and suffering?

  1. New Testament
  2. Genesis
  3. Old Testament.
  4. Leviticus

Question 12 The nurse overhears a patient ask a family member to bring the Lourdes water to the hospital. The nurse recalls that this water is believed to cure which health problem?

  1. Bodily ills
  2. Blindness
  3. Mental Illness
  4. Cancer

Question 13 A patient follows the teachings of Christian Science and will not take any medications, but for which health problem will medications be used by members of this religion?

  1. Immunizations to comply with civil law
  2. Chemotherapy to treat cancer
  3. Antibiotics
  4. Narcotics for pain relief

Question 14 An adolescent patient is having a moral conflict because an abortion is desired but it is against the patient’s religion. Which religions forbid or restrict abortions?

Select all that apply.

  1. Roman Catholicism
  2. Christian Science
  3. Church of Jesus Christ of Latter-day Saints
  4. Unitarian Church

Question 15 A family member tells a patient with terminal cancer not to worry since special prayers have been said in church. To which saint is prayed for help with cancer?

  1. St. Dymphna
  2. St. Odilia
  3. St. Lucy
  4. St. Peregrine

Question 16 A patient adheres to the teachings of Seventh-day Adventist. What practice is followed by those within this religion?

  1. Abstinence from alcohol, coffee, and tea
  2. Avoid pork
  3. Fasting once a month
  4. Follow a vegetarian diet

Question 17 The nurse is reading about ancient forms of healing. Which method focuses on removing evil from the body?

  1. Casting blame on another person in the community
  2. Drinking special herbal mixtures
  3. Eating special foods
  4. Punishing the person who had the sickness

Question 18 A female patient tells the nurse that she prayed to one saint to become pregnant, and now that she is, she is going to pray to a different saint to help her through the pregnancy. To which saints is this patient praying?

Select all that apply.

  1. St. Anthony of Padua
  2. St. Raymond Nonnatus
  3. St. Lucy
  4. St. John of God

Question 19 A patient who is Buddhist is wearing white clothes. What does this color symbolize in this religion?

  1. Mourning the death of a relative
  2. Joy for the birth of an infant
  3. Recognition of a religious holiday
  4. Celebration of a marriage

Question 20 Which type of healing is most appropriate for a person who is possessed by external evil?

  1. Deliverance
  2. Physical HEALING
  3. Inner HEALING
  4. Spiritual HEALING

Pathophysiology Case Study

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No Plegarism please, assignemnt will be checked with Turnitin.

Will need 4 full pages double spaced for the case study, APA Style, Times New Roman, font 12, Title Page and a Reference page.

In your discussion be sure to include evidence of your knowledge of tissue and organ structure and function to physiologic alterations in systems and analyze the cause and effect relationship in response to disease.

Make sure all of the questions in the case study have been addressed and answered.

Cite at least 3 References; journal articles, textbooks, or evidenced-based websites to support the content. 3.

All sources must be within five years (2012-2017).

Case Study 7 Disorders of Hemostasis

Leona is 52 years old and smokes. She is also overweight and has atherosclerosis. When she was given a two-week vacation from work, she packed up her bags and flew from Minnesota to Sydney, Australia, for the trip she always wanted to take. Unfortunately, just three days after she arrived, she was hospitalized when her left calf became inflamed, causing her considerable pain. The physician attending to her told her she developed a deep vein thrombosis.

Explain, using your knowledge of hypercoagulability, why the trip to Australia contributed to Leona’s DVT?

Why was Leona already at risk for thrombus development?How does Leona’s atherosclerosis affect platelet function? Conversely, what is the effect of increased platelet activity on the development of atherosclerosis?

How do atherosclerosis and immobility promote changes in blood coagulation?

When Leona was in hospital, she received heparin therapy. Explain why this course of action was taken to treat her DVT. Why was she not given heparin tablets to take back to the hotel with her?

Case Scenario

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The case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

Ms. G., a 23-year-old diabetic, is admitted to the hospital with a cellulitis of her left lower leg. She has been applying heating pads to the leg for the last 48 hours, but the leg has become more painful and she has developed chilling.

Subjective Data

Complains of pain and heaviness in her leg.

States she cannot bear weight on her leg and has been in bed for 3 days.

Lives alone and has not had anyone to help her with meals.

Objective Data

Round, yellow-red, 2 cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainage

Left leg red from knee to ankle

Calf measurement on left 3 in > than right

Temperature: 38.9 degrees C

Height: 160 cm; Weight: 83.7 kg

Laboratory Results

WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands

Wound culture: Staphylococcus aureus

Critical Thinking Questions

What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.

Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”

What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.

What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

Practicum – Assessing Client Families

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To prepare:

· Select a client family that you have observed or counseled at your practicum site.

· Review pages 137–142 of Wheeler (2014) and the Hernandez Family Genogram

video in this week’s Learning Resources. (SEE ATTACHED VIDEO TRANSCRIPT)

· Reflect on elements of writing a comprehensive client assessment and creating a

genogram for the client you selected.

                                                                     The Assignment





                                      Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:

· Demographic information

· Presenting problem

· History or present illness

· Past psychiatric history

· Medical history

· Substance use history

· Developmental history

· Family psychiatric history

· Psychosocial history

· History of abuse and/or trauma

· Review of systems

· Physical assessment

· Mental status exam

· Differential diagnosis

· Case formulation

· Treatment plan

                                            Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).

N:B. (1)PLEASE THIS ASSIGNMENT HAS 2 PARTS, AND I HAVE ATTACHED A SAMPLE OF THE ASSIGNMENT, BUT THE SAMPLE TALKS ONLY ABOUT HERNANDEZ, BUT THIS ASSIGNMENT IS FOCUS ON HERNANDEZ FAMILY.

(2). HERNANDEZ FAMILY GENOGRAM VIDEO TRANSCRIPT IS ATTACHED INCASE YOU CAN NOT VIEW THE VIDEO

                                                  Learning Resources

Required Readings

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

Chapter 8, “Experiential Family Therapy” (pp. 129–147)

Chapter 13, “Narrative Therapy” (pp. 243–258)

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

“Genograms” pp. 137-142

Cohn, A. S. (2014). Romeo and Julius: A narrative therapy intervention for sexual-minority couples. Journal of Family Psychotherapy, 25(1), 73–77. doi:10.1080/08975353.2014.881696

Escudero, V., Boogmans, E., Loots, G., & Friedlander, M. L. (2012). Alliance rupture and repair in conjoint family therapy: An exploratory study. Psychotherapy, 49(1), 26–37. doi:10.1037/a0026747

Freedman, J. (2014). Witnessing and positioning: Structuring narrative therapy with families and couples. Australian & New Zealand Journal of Family Therapy, 35(1), 20–30. doi:10.1002/anzf.1043

Phipps, W. D., & Vorster, C. (2011). Narrative therapy: A return to the intrapsychic perspective. Journal of Family Psychotherapy, 22(2), 128–147. doi:10.1080/08975353.2011.578036

Saltzman, W. R., Pynoos, R. S., Lester, P., Layne, C. M., & Beardslee, W. R. (2013). Enhancing family resilience through family narrative co-construction. Clinical Child and Family Psychology Review, 16(3), 294–310. doi:10.1007/s10567-013-0142-2

                                                Required Media

Governors State University (Producer). (2009). Emotionally focused couples therapy [Video file]. Chicago, IL: Author.

Laureate Education (Producer). (2013b). Hernandez family genogram [Video file]. Baltimore, MD: Author. (SEE ATTACHED VIDEO TRANSCRIPT)

Psychotherapy.net (Producer). (1998). Narrative family therapy [Video file]. San Francisco, CA: Author.

Nursing Informatics

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Workflow analysis aims to determine workflow patterns that maximize the effective use of resources and minimize activities that do not add value. There are a variety of tools that can be used to analyze the workflow of processes and clarify potential avenues for eliminating waste. Flowcharts are a basic and commonly used workflow analysis method that can help highlight areas in need of streamlining.

In this Assignment, you select a common event that occurs regularly in your organization and create a flowchart representing the workflow. You analyze the process you have diagrammed and propose changes for improvement.

To prepare:

Identify a common, simple event that frequently occurs in your organization that you would like to evaluate.

Consider how you would design a flowchart to represent the current workflow.

Consider what metrics you would use to determine the effectiveness of the current workflow and identify areas of waste.

To complete:

Write a 3- to 5-page paper which includes the following:

Create a simple flowchart of the activity you selected. (Review the Sample Workflow of Answering a Telephone in an Office document found in this week’s Learning Resources for an example.)

Next, in your paper:

Explain the process you have diagrammed.

For each step or decision point in the process, identify the following:

Who does this step? (It can be several people.)

What technology is used?

What policies and rules are involved in determining how, when, why, or where the step is executed?

What information is needed for the execution of this step?

Describe the metric that is currently used to measure the soundness of the workflow. Is it effective?

Describe any areas where improvements could occur and propose changes that could bring about these improvements in the workflow.

Summarize why it is important to be aware of the flow of an activity.

Remember to include a cover page, introduction, and summary for your paper.

Nursing Exam

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Question 1: In an outpatient setting, what is the most common reason for a malpractice suit?

a. Failure to treat a condition

b. Failure to diagnose correctly

c. Ordering the wrong medication

d. Failure to manage care

Question 2: How often should the clinician examine the feet of a person with diabetes?

a. Once a year

b. Every 6 months

c. Every 3 months

d. Every visit

Question 3: Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis?

a. Cholinesterase inhibitors

b. Anxiolytics

c. Antidepressants

d. Atypical antipsychotics

Question 4: Which of the following medications is the treatment of choice for trichomonas?

a. Metranidazole

b. Ceftriaxone

c. Diflucan

d. Doxycycline

Question 5: Most adult poisonings are:

a. intentional and self-inflicted.

b. accidental.

c. caused by someone wishing to do harm to the person.

d. not attributed to any reason.

Question 6: A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?

a. “It is probably just a cyst, because that is the most common breast mass.”

b. “We will order a mammogram and ultrasound to help establish a diagnosis.”

c. “We will go ahead and schedule you for a biopsy because that is the only way to know for sure.”

d. “Because your lump is painful, it is most likely not cancer.”

Question 7: Which of the following is a specific test for multiple sclerosis (MS)?

a. Magnetic resonance imaging (MRI)

b. Computed tomography (CT) scan

c. A lumbar puncture

d. There is no specific test.

Question 8: After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?

a. Suggest she use a heating pad to improve circulation

b. Refer to a podiatrist for a foot care treatment plan

c. Send her for acupuncture treatments

d. All of the above

Question 9: Which characteristic of delirium helps to distinguish delirium from dementia?

a. Abrupt onset

b. Impaired attention

c. Affective changes

d. Delusions

Question 10: Which clinical feature is the first to be affected in increased intracranial pressure (ICP)?

a. Decrease in level of consciousness (LOC)

b. Headache

c. Nausea

d. Widening pulse pressure

Question 11: Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited range of motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?

a. Posterior dislocations are more common than anterior dislocations.

b. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses.

c. Recurrent dislocations are uncommon and would require a greater force to result in injury.

d. Surgery is most commonly the treatment of choice.

Question 12: In the consensus model for Advanced Practice Registered Nurse (APRN) regulation, the “C” of LACE represents?

a. Commitment

b. Consensus

c. Certification

d. Collaboration

Question 13: Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?

a. Decreased C-reactive protein

b. Hyperalbuminemia

c. Morning stiffness

d. Weight gain

Question 14: Which of the following statements is true concerning the musculoskeletal exam?

a. The uninvolved side should be examined initially and compared to the involved side.

b. The part of the body that is causing the patient pain should be examined first.

c. The patient should not be asked to perform active range-of-motion (ROM) exercises whenever possible to avoid causing pain.

d. Radiographs should always be obtained prior to examination so as not to cause further injury to the patient.

Question 15: The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?

a. Overweight

b. Mild obesity

c. Moderate obesity

d. Morbid obesity

Question 16: S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician suspect in the initial test results for this patient?

a. Elevated uric acid level

b. Elevated blood urea nitrogen (BUN)

c. Decreased urine pH

d. Decreased C-reactive protein (CRP)

Question 17: Which of the following statements is true regarding the treatment of carpal tunnel syndrome?

a. The goal of treatment is to prevent flexion and extension movements of the wrist.

b. Splints are used in carpal tunnel syndrome because they allow for free movement of the fingers and thumb while maintaining the wrist in a neutral position.

c. Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome because of the risks for median nerve damage, scarring, and infection.

d. All of the above

Question 18: The vegetarian patient with gout asks the clinician about food that he should avoid. The clinician should advise the patient to avoid which of the following foods?

a. Rice

b. Carrots

c. Spinach

d. Potatoes

Question 19: A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her exam?

a. Human papillomavirus (HPV)

b. Endometrial hyperplasia

c. Vagismus

d. Polycystic ovarian syndrome

Question 20: Which patient is more likely to have a cluster headache?

a. A female in her reproductive years

b. A 40-year-old African American male

c. A 55-year-old female who drinks 10 cups of coffee daily

d. A 45-year-old male awakened at night

Question 21: A sunscreen with a sun-protection factor (SPF) of at least what number will block most harmful ultraviolet (UV) radiation?

a. 4

b. 8 d

c. 10

d. 15

Question 22: Which of the following classes of drugs should be used as first-line therapy for treatment of delirium?

a. Benzodiazepines

b. Antipsychotics

c. Anticonvulsants

d. Antidepressants

Question 23: What is the treatment of choice for a patient diagnosed with testicular cancer?

a. Radical orchidectomy

b. Lumpectomy

c. Radiation implants

d. All of the above

Question 24: Sam, aged 65, is started on L-dopa for his Parkinson’s disease (PD). He asks why this is necessary. You tell him:

a. “L-dopa is neuroprotective.”

b. “The primary goal of therapy is to replace depleted stores of dopamine.”

c. “This is the only drug that can provide symptomatic benefit.”

d. “This is the initial monotherapy drug.”

Question 25: A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?

a. The scrotum will be dark.

b. The scrotum will appear light pink or yellow.

c. The scrotum will appear milky white.

d. The internal structures will be clearly visible.

Question 26: A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease (STD) has she most probably been exposed to?

a. Gonorrhea

b. Human papillomavirus (HPV)

c. Chlamydia

d. Trichomonas

Question 27: A 58-year-old woman who had a total abdominal hysterectomy at the age of 45 is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment?

a. Conjugated estrogen 0.625 mg/day oral

b. Estradiol 7.5 mcg/24 hr vaginal ring

c. Medroxyprogesterone 10 mg/day oral

d. Conjugated estrogen 0.3 mg + medroxyprogesterone 1.5 mg/day oral

Question 28: When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are?

a. Conjugated estrogen 0.625 mg/day oral

b. Estradiol 7.5 mcg/24 hr vaginal ring

c. Medroxyprogesterone 10 mg/day oral

d. Conjugated estrogen 0.3 mg + medroxyprogesterone 1.5 mg/day oral

Question 29: A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self-examination (TSE). Which of the following should be included in the list of differential diagnoses?

a. Testicular cancer

b. Inguinal hernia

c. Varicocele

d. All of the above

Question 30: The clinician should Question: the patient with suspected gout about use of which of these medications that may be a risk factor?

a. Low-dose aspirin

b. Thiazide diuretics

c. Ethambutol

d. All of the above

Question 31: What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster?

a. A stabbing type of pain on one small area of the body

b. A vesicular skin lesion on one side of the body

c. A pain that is worse upon awakening

d. A lesion on the exterior ear canal

Question 32: Which ethical principle reflects respect for all persons and their self-determination?

a. Autonomy

b. Beneficence

c. Justice

d. Veracity

Question 33: Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point?

a. 10%

b. 20%

c. 30%

d. 50%

Question 34: John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?

a. Valgus stress test

b. McMurray circumduction test

c. Lachman test

d. Varus stress test

Question 35: Which of the following laboratory findings should the clinician expect in a patient with untreated Graves’ disease?

a. Elevated thyroid-stimulating hormone (TSH)

b. Elevated T4

c. Elevated TRH

d. All of the above

Question 36: Which drug commonly prescribed for burns is active against a wide spectrum of microbial pathogens and is the most frequently used agent for partial- and full-thickness thermal injuries?

a. Clotrimazole cream (Lotrimen)

b. Mafenide acetate (Sulfamylon)

c. Silver nitrate

d. Silver sulfadiazine (Silvadene)

Question 37: During a digital rectal exam (DRE) on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

a. An enlarged rubbery gland

b. A hard irregular gland

c. A tender gland

d. A boggy gland

Question 38: Janet is a 30-year-old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?

a. Gastrocnemius weakness

b. A reduced or absent ankle reflex

c. Numbness in the lateral foot

d. Paresthesia of the perineum and buttocks

Question 39: The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (text revision) (DSM-IV-TR) state that excessive worry or apprehension must be present more days than not for at least:

a. 1 month.

b. 3 months.

c. 6 months.

d. 12 months.

Question 40: The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs to manage his pain?

a. You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.

b. You should start with the lowest dose that is effective in managing your pain in order to avoid developing tolerance to the medication.

c. You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain.

d. It is important to take NSAIDs on an empty stomach in order to increase absorption.

Question 41: A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram (ECG) changes should the clinician expect as a manifestation of the disease?

a. Sinus bradycardia

b. Atrial fibrillation

c. Supraventricular tachycardia

d. U waves

Question 42: Sam is a 25-year-old man who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?

a. Morning stiffness and limited mobility of the lumbar spine

b. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain

c. Fever, chills, and elevated erythrocyte sedimentation rate

d. Pathologic fractures, severe night pain, weight loss, and fatigue

Question 43: Which type of burn injury results in destruction of epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?

a. Superficial burns

b. Superficial partial-thickness burns

c. Deep partial-thickness burns

d. Full-thickness burns

Question 44: Immunizations are an example of which type of prevention?

a. Primary

b. Secondary

c. Tertiary

Question 45: If a previously frostbitten area becomes frostbitten again after it has healed, what might occur?

a. Permanent tissue damage may occur, resulting in necrosis to that body part.

b. The area will be super sensitive.

c. The area is prone to a repeat frostbite.

d. The area is as susceptible as any other area.

Question 46: In the United States, what is the second most common connective tissue disease and the most destructive to the joints?

a. Osteoarthritis

b. Systemic lupus erythematosus (SLE)

c. Rheumatoid arthritis (RA)

d. Sjogren’s syndrome

Question 47: A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?

a. Pregnancy test

b. Pelvic ultrasound .

c. Endometrial biopsy

d. Platelet count

Question 48: A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding?

a. Trichomonas

b. Bacterial vaginosis

c. Human papillomavirus (HPV)

d. Herpes simplex virus (HSV)

Question 49: Julie, aged 50, has migraine headaches, frequent asthma attacks, coronary artery disease, and hypertension. Which of the following prophylactic medications would you order for her migraines?

a. Propranolol

b. Timolol

c. Ergotamine

d. Topiramate

Question 50: A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment?

a. Tricyclic antidepressants

b. Capsacin cream

c. Vitamin B12 injections

d. Insulin