N521- Advanced Pharmacology Discussion 8

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N521- Advanced Pharmacology Discussion 8

J. L., a 27-year-old African-American female account executive, presents to the Family Medicine office for her annual checkup with her CNP. She has no significant past medical history. Her medications include calcium carbonate 500 mg orally twice a day and a multivitamin daily. She exercises regularly. Her family history is significant for cardiovascular disease (her father had an MI at age 54 and died of a further MI at age 63). She notes that she has been dating her current partner for approximately 5 months. She is interested in a reliable form of contraception. After discussing the various contraceptive options, she decides that an oral contraceptive (OC) would best fit her needs J. L., a 27-year-old African-American female account executive, presents.

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In this discussion forum:

  1. Discuss what tests or examinations the CNP would likely perform before prescribing an OC regimen, and why.
  2. Discuss two different OC regimens that could be chosen for J. L. Discuss their differences and why you chose them.
  3. Discuss the potential side effects of each OC regimen that need to be relayed to J. L. Discuss especially those effects for which she should seek immediate medical care. J. L., a 27-year-old African-American female account executive, presents
  4. Discuss health promotion recommendations you would consider for J. L.
  5. What ethical issues should be considered?

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. J. L., a 27-year-old African-American female account executive, presents. N521- Advanced Pharmacology Discussion 8

N521- Advanced Pharmacology Reproductive System Medications

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N521- Advanced Pharmacology Reproductive System Medications

Module 8 Overview

Introduction

This week we will focus on the pharmacotherapeutics of reproductive system disorders, including commonly occurring conditions and their commonly prescribed medications.

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Learning Objectives

After completing this module, you will be able to:

  • Utilize advanced nursing and pharmacological interventions in reproductive system disorders to resolve complex and biological, psychological, physiological and pathophysiologic conditions. N521- Advanced Pharmacology Reproductive System Medications
  • Teach patients, family members, and others from diverse populations regarding safe and effective use of drugs and natural products in reproductive system disorders. N521- Advanced Pharmacology Reproductive System Medications

Reading & Resources

Read Chapters 55-58 & 36-37 in Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. N521- Advanced Pharmacology Reproductive System Medications

Learning Activities

  • Discussion: Participate in Discussion 8.
  • Assignment: NA
  • Test: Complete Progress Test 4. Click on the Progress Test 4 link for more details.
  • Evaluations: Complete the Student Course Evaluation.

Discussion 8

J. L., a 27-year-old African-American female account executive, presents to the Family Medicine office for her annual checkup with her CNP. She has no significant past medical history. Her medications include calcium carbonate 500 mg orally twice a day and a multivitamin daily. She exercises regularly. Her family history is significant for cardiovascular disease (her father had an MI at age 54 and died of a further MI at age 63). She notes that she has been dating her current partner for approximately 5 months. N521- Advanced Pharmacology Reproductive System Medications She is interested in a reliable form of contraception. After discussing the various contraceptive options, she decides that an oral contraceptive (OC) would best fit her needs.

In this discussion forum:

  1. Discuss what tests or examinations the CNP would likely perform before prescribing an OC regimen, and why.
  2. Discuss two different OC regimens that could be chosen for J. L. Discuss their differences and why you chose them.
  3. Discuss the potential side effects of each OC regimen that need to be relayed to J. L. Discuss especially those effects for which she should seek immediate medical care.
  4. Discuss health promotion recommendations you would consider for J. L.
  5. What ethical issues should be considered? N521- Advanced Pharmacology Reproductive System Medications

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria N521- Advanced Pharmacology Reproductive System Medications.

N512 Assignment 1 fragile X-associated mental retardation

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N512 Assignment 1 fragile X-associated mental retardation

The purpose of this N512 Assignment 1 fragile X-associated mental retardation paper is to address the following clinical scenario with the use of your textbook, external credible literature, and/or reliable electronic sources. Use the guide below to draft your paper and review the rubric to ensure you have met the assignment criteria. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).

Lisa Anderson, a 22 y.o., Caucasian single parent, is referred for genetic counseling by her pediatric Nurse Practitioner. She has a 3-year-old boy with developmental delay and small joint hyperextensibility. The pediatric Nurse Practitioner has diagnosed fragile X-associated mental retardation. She is currently pregnant with her second child at 14 weeks of gestation. The family history is unremarkable. N512 Assignment 1 fragile X-associated mental retardation

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Please use the following headings/subheadings as a guide to draft your paper:

  1. Introduction (including a brief purpose statement)
  2. Identify the genetic mutation responsible for fragile X-associated mental retardation.
  3. Describe and discuss how it causes the clinical syndrome of developmental delay, joint hyperextensibility, large testes, and facial abnormalities.
  4. Identify which parent is the probable carrier of the genetic mutation?
  5. Explain why this parent and the grandparents are phenotypically unaffected.
  6. Discuss the likelihood that the unborn child will be affected? N512 Assignment 1 fragile X-associated mental retardation

VII. Conclusion

In regards to APA format, please use the following as a guide:

  • Include a cover N512 Assignment 1 fragile X-associated mental retardation page and running head (this is not part of the 4-5 page limit)
  • Include transitions in your paper (i.e. headings or subheadings)
  • Use in-text references throughout the paper
  • Use double space, 12 point Times New Roman font
  • Spelling, grammar, and organization are appropriate
  • Include a reference list (this is not part of the 4-5 page limit)
  • Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA) N512 Assignment 1 fragile X-associated mental retardation

Assignment 1 Rubric

Criteria

60 Points

55 Points

50  Points

40 Points

Earned Points

Content: Application & Analysis

 Responds correctly and/or appropriately to all questions and criteria. Content is excellent. 

Demonstrates a high level of critical thinking, shows significant insight or creative thought about the topic, and does not merely recite the text/resources. Uses concepts and terminology correctly.  Detail rich and specific.

 Responds correctly and/or appropriately to all questions and criteria. Content is good. 

Demonstrates some critical thinking throughout the paper and may also show some insight or creative thinking about the topic. Mostly uses concepts and terminology correctly (1-2 issues). Minor detail inconsistencies (1-2).

 Responds correctly and/or appropriately to at least one question OR if only one question, partially responds to question. Does not address all criteria. Content is minimal. 

Demonstrates at least one critical thinking skill in the paper.  Attempts to use concepts and terminology correctly.  Several detail inconsistencies (3-5).

 Paper is unclear and does not address the questions and/or criteria. Content does not meet requirements. Many inconsistencies and conflicting information (6+). 

 

 

 /60

Criteria

20 Points

16 Points

14 Points

12 Points

Earned Points

Quality: Supporting Research & Sources

 All work is accurately cited (where applicable) and appropriately supports content with research, text, multimedia, and/or other resources.  References are relevant and enhance the topic. Most of the work is accurately cited (where applicable) and adequately supports content with research, text, and/or resources.  One issue with reference or use of one inappropriate reference.  References are relevant to the topic. 2-3 issues with references, including the use of inappropriate references to support content. May fail to provide references to support content.  1-2 references are not relevant to the topic and/or distract from the topic at hand. 4 or more issues with references, including the use of inappropriate references to support content OR failure to include references (where applicable).  No supporting references are used OR they are used but 3+ references are not relevant to the topic. /20 

N512 Assignment 1 fragile X-associated mental retardation

Criteria

10 Points

8 Points

7 Points

6 Points

Earned Points

Organization

 Paper is well-organized. Ideas are clear and arranged logically. Transitions are smooth, no flaws in logic. Paper is organized. Ideas are usually clear and arranged in an acceptable sequence (1-2 issues). Transitions are usually smooth (1-2 issues), good support. Paper lacks organization. There are many problems with the approach (3-5 issues with organization). Some difficulty understanding ideas.  Issues with support and transitions (3-5). Paper is poorly organized and difficult to understand. Many issues with support and transitions (6+). Ideas are arranged illogically and do not make sense.  /10

Accuracy & Basic Writing Mechanics

 Error-free, including APA formatting, reflecting clear understanding of various forms of expression and careful editing. Very few (less than 3) errors in spelling, grammar, syntax, and/or punctuation. Very few (less than 3) issues with APA formatting. Occasional poor choice of word. 4-5 errors in spelling, grammar, syntax, and/or punctuation. 4-5 issues with APA Formatting. Writing may be difficult to understand at times. N512 Assignment 1 fragile X-associated mental retardation More than 5 errors in spelling, grammar, syntax, and/or punctuation.  Many (6+ issues with APA formatting.  Writing is difficult to understand in many instances.

Fragile x Syndrome Essay Assignment

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Fragile x Syndrome Essay Assignment

Fragile X Syndrome: A Case Discussion

According to the CDC (2020), Fragile X Syndrome (FXS) is the most commonly known cause of inherited intellectual disability. Fragile X syndrome occurs in approximately 1 in 4,000 males and 1 in 8,000 females, (NIH,2020). It is an X-linked inherited disorder that causes cognitive impairments as well as distinct physical characteristics. The syndrome affects the CNS, the testes, and the cranial skeleton.

The case given is, patient L.A. has a 3-year-old boy with developmental delay and small joint hyperextensibility. She has been diagnosed with fragile X-associated mental retardation and is currently 14 weeks pregnant. Screening to identify the sex of the baby as well as genetic testing is vital, as this information will assist the Nurse practitioner in counseling the patient appropriately on what to expect and providing early intervention and support.  Given that her first child has the disorder, there is a 50% chance that her second child will be affected.  If her baby is a boy, the clinical manifestations will be more severe; A girl may only exhibit subtle impairments.   In this paper, the pathogenesis and the clinical manifestations of fragile X syndrome will be discussed. Fragile x Syndrome Essay Assignment

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Fragile X Genetic Mutation

Mutations in the FMR1 gene produces Fragile X syndrome. The FMR1 gene, also known as the Fragile X mental retardation gene locus, is found on the X chromosome, where it is most fragile, hence the name Fragile X.  At the beginning of the FMR1 gene, there is a trinucleotide sequence, known by the letters CGG, in individuals who are neither infected nor carriers, the CGG repeat is fewer than 50. CGG repeats greater than 200 results in abnormal chemical changes, known as methylation. This aberration results in a full mutation of the FMR1 gene. This mutation prevents the production of FMRP. FRMP is a protein found in tissues of the brain and testes and is needed for healthy development. In the absence of the FMRP protein, cognitive disabilities and some discernable physical features occur. Since the disorder is X linked, the mutation of the FMR1 gene is fully expressed in males. Males carry only one copy of the x chromosome.  In males with Fragile X syndrome, the abnormal x linked chromosome does not have another X chromosome to balance out the abnormality, resulting in the disorder’s full expression. Females have two X chromosomes, therefore, a mutation in one X chromosome will not present with the same severity, as the other X chromosome compensates for the defective chromosome (Stone et al., 2020).

Clinical Syndromes of Fragile X

The loss of function of the FMR1 protein causes an alteration in the neuronal synapse development, resulting in developmental delay and cognitive disabilities by 1-2 years, as seen in Ms. Anderson’s 3yr old son.  Patients with Fragile X may also present a plethora of behavioral issues, including hyperactivity and autistic behaviors (Stone et al., 2020).  These manifestations are more pronounced in males than females.  The physical characteristics of the syndrome in males may not become apparent until late in childhood or early adolescence. These physical characteristics include the coarsening of facial features, large ears, a long face, crossed eyes, and a large head. Affected males will also start to exhibit large testes.

Other clinical manifestations of the syndrome may include joint laxity, scoliosis, recurrent, and otitis media.  Adults with Fragile X syndrome may also suffer from cardiac problems such as mitral valve prolapses, seizures. Autism spectrum disorder is also a common sequela of Fragile X syndrome (Stone et al., 2020). fragile x syndrome essay assignment

Heredity

Parent

As mentioned earlier, Fragile X syndrome is an X-linked disorder. In X-linked disorders, males are affected, while females may exhibit subtle characteristics; some females will not show any signs of disorder but carry the affected gene. Regarding the case of Ms. Anderson, given that her first son exhibits signs of Fragile X, she is likely to be a carrier of the affected gene.  Males inherit the X chromosome from their mothers, and the Y chromosomes from their fathers, therefore, in the case of Ms. Anderson, she is the source of the mutation. If her baby is a boy, there is a 50% chance he will be affected, and if it is a girl, she will be a carrier of the disorder. fragile x syndrome essay assignment

Grandparents

        The family history is unremarkable, which means no other males in the family exhibited any characteristics associated with the disorder. With this knowledge, Ms. Anderson’s mother was likely a carrier of the gene. Given that females carry X X chromosomes combination, Ms. Anderson would have received one X chromosome from her father and another X chromosome from her mother. If she had received the defective X chromosome from her father, he would have been phenotypically affected. Since her family history suggested otherwise, therefore, it is unlikely that Ms. Anderson inherited Fragile X from her father, which leaves the other X chromosome inherited from her mother. We now know that females can carry the gene without showing signs of the disorder.   The additional X chromosome made up of the loss of function of the defective chromosome. As a result, Ms. Anderson’s mother was not phenotypically affected but carried the gene fragile x syndrome essay assignment.

Siblings

Any offspring of Ms. Anderson will have the FMR1 gene mutation, as it is passed on via the X chromosome. However, a female child will present with a milder form of the illness, if any. All male siblings will be affected because they will receive the only one and defective copy of the X chromosome from their mother.

There may be other factors that can affect the presentation of the gene in the offspring. Recent studies have shown an AGG interruption in the CGG repeats of the defective gene reduces the chances of having a full mutation of the FMR1 gene (Nolin, et al., 2015). This discovery highlights the importance for patients to undergo genetic testing to thoroughly analyze the risk of carrying another child with Fragile X syndrome. Diagnosis of the illness is made through molecular genetic testing of FMR1 gene. The gene is characterized by the number of CGG repeats a person will have. Prenatal diagnostic testing involves Chorionic villus sampling and amniocentesis fragile x syndrome essay assignment. These tests will determine if a fetus has inherited the gene.

Conclusion

Fragile X Syndrome is an inherited disorder. It is known to be a common cause of intellectual disability. Patients who carry the gene should be counseled for the likelihood that their children will also have the disorder. Considering that it is an X linked disorder, the severity of the manifestations depends on the gender of the offspring.  In the case of Lisa Anderson, she is a genetic carrier of Fragile X syndrome. Her first male child already presents with the clinical manifestations of the disorder. There is a 50% chance another male child will also be affected. If her second offspring is female, she may present normal or with only mild features of the disorder.

Fragile X syndrome can go undiagnosed. Therefore, a thorough family history assessment should be done.  If one or more family member is found to have behavioral or physical characteristics indicative of the disorder, genetic counseling should be recommended. In the case of Ms. Anderson, genetic counseling will provide her with information on the disorder’s inheritance, implications, testing, and available resources.  It will also help her to adjust to the diagnosis as well as have realistic expectations. Fragile x Syndrome Essay Assignment

 

References

Ciaccio, C., Fontana, L., Milani, D., Tabano, S., Miozzo, M., & Esposito, S. (2017). Fragile X syndrome: a review of clinical and molecular diagnoses. Italian Journal Of Pediatrics, 43(1). https://doi.org/10.1186/s13052-017-0355-y

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. (n.d.). Fragile X syndrome: Learning what families need, one person at a time. Center For Disease Control and Prevention. Retrieved August 14, 2020, from https://www.cdc.gov/ncbddd/fxs/features/learning-what-families-need.html

Nolin, S. L., Glicksman, A., Ersalesi, N., Dobkin, C., Brown, W. T., Cao, R., Blatt, E., Sah, S., Latham, G. J., & Hadd, A. G. (2015). Fragile X full mutation expansions are inhibited by one or more AGG interruptions in premutation carriers. Genetics in medicine: official journal of the American College of Medical Genetics, 17(5), 358–364. https://doi.org/10.1038/gim.2014.106

National Institute of Health. (2020, August 4). Fragile X Syndrome. https://ghr.nlm.nih.gov/condition/fragile-x-syndrome

Stone, W., Basit, H., & Los, E. (2020). StatPearls [Ebook] (p. Fragile X Syndrome). StatPearls Publishing. Retrieved 4 August 2020, from https://www.ncbi.nlm.nih.gov/books/NBK459243/.  fragile x syndrome essay assignment

 

Assignment 1

The purpose of this paper is to address the following clinical scenario with the use of your textbook, external credible literature, and/or reliable electronic sources. Use the guide below to draft your paper and review the rubric to ensure you have met the assignment criteria. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).

Lisa Anderson, a 22 y.o., Caucasian single parent, is referred for genetic counseling by her pediatric Nurse Practitioner. She has a 3-year-old boy with developmental delay and small joint hyperextensibility. The pediatric Nurse Practitioner has diagnosed fragile X-associated mental retardation. She is currently pregnant with her second child at 14 weeks of gestation. The family history is unremarkable.

 

Please use the following headings/subheadings as a guide to draft your fragile x syndrome essay assignment paper:

  1. Introduction (including a brief purpose statement)
  2. Identify the genetic mutation responsible for fragile X-associated mental retardation.
  3. Describe and discuss how it causes the clinical syndrome of developmental delay, joint hyperextensibility, large testes, and facial abnormalities.
  4. Identify which parent is the probable carrier of the genetic mutation?
  5. Explain why this parent and the grandparents are phenotypically unaffected.
  6. Discuss the likelihood that the unborn child will be affected?

VII. Conclusion

In regards to APA format, please use the following as a guide:

  • Include a cover page and running head (this is not part of the 4-5 page limit)
  • Include transitions in your paper (i.e. headings or subheadings)
  • Use in-text references throughout the fragile x syndrome essay assignment paper
  • Use double space, 12 point Times New Roman font
  • Spelling, grammar, and organization are appropriate
  • Include a reference list (this is not part of the 4-5 page limit)
  • Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA) Fragile x Syndrome Essay Assignment

Assignment 1 Rubric

Criteria

60 Points

55 Points

50  Points

40 Points

Earned Points

Content: Application & Analysis

 Responds correctly and/or appropriately to all questions and criteria. Content is excellent. 

Demonstrates a high level of critical thinking, shows significant insight or creative thought about the topic, and does not merely recite the text/resources. Uses concepts and terminology correctly.  Detail rich and specific.

 Responds correctly and/or appropriately to all questions and criteria. Content is good. 

Demonstrates some critical thinking throughout the paper and may also show some insight or creative thinking about the topic. Mostly uses concepts and terminology correctly (1-2 issues). Minor detail inconsistencies (1-2).

 Responds correctly and/or appropriately to at least one question OR if only one question, partially responds to question. Does not address all criteria. Content is minimal. 

Demonstrates at least one critical thinking skill in the paper.  Attempts to use concepts and terminology correctly.  Several detail inconsistencies (3-5).

 Paper is unclear and does not address the questions and/or criteria. Content does not meet requirements. Many inconsistencies and conflicting information (6+). 

fragile x syndrome essay assignment

 

 /60

Criteria

20 Points

16 Points

14 Points

12 Points

Earned Points

Quality: Supporting Research & Sources

 All work is accurately cited (where applicable) and appropriately supports content with research, text, multimedia, and/or other resources.  References are relevant and enhance the topic. Most of the work is accurately cited (where applicable) and adequately supports content with research, text, and/or resources.  One issue with reference or use of one inappropriate reference.  References are relevant to the topic. 2-3 issues with references, including the use of inappropriate references to support content. May fail to provide references to support content.  1-2 references are not relevant to the topic and/or distract from the topic at hand. 4 or more issues with references, including the use of inappropriate references to support content OR failure to include references (where applicable).  No supporting references are used OR they are used but 3+ references are not relevant to the topic. /20 

fragile x syndrome essay assignment

Criteria

10 Points

8 Points

7 Points

6 Points

Earned Points

Organization

 Paper is well-organized. Ideas are clear and arranged logically. Transitions are smooth, no flaws in logic. Paper is organized. Ideas are usually clear and arranged in an acceptable sequence (1-2 issues). Transitions are usually smooth (1-2 issues), good support. Paper lacks organization. There are many problems with the approach (3-5 issues with organization). Some difficulty understanding ideas.  Issues with support and transitions (3-5). Paper is poorly organized and difficult to understand. Many issues with support and transitions (6+). Ideas are arranged illogically and do not make sense.  /10

Accuracy & Basic Writing Mechanics

 Error-free, including APA formatting, reflecting clear understanding of various forms of expression and careful editing. Very few (less than 3) errors in spelling, grammar, syntax, and/or punctuation. Very few (less than 3) issues with APA formatting. Occasional poor choice of word. 4-5 errors in spelling, grammar, syntax, and/or punctuation. 4-5 issues with APA Formatting. Writing may be difficult to understand at times. More than 5 errors in spelling, grammar, syntax, and/or punctuation.  Many (6+ issues with APA formatting.  Writing is difficult to understand in many instances.  /10 fragile x syndrome essay assignment

Jackie Johnson Acute Pericarditis discussion

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Jackie Johnson Acute Pericarditis discussion

Jackie Johnson is described as a married 35-year-old African American female who has presented to the emergency room with: Chest pain, which she rates 8 out of 10 on a scale ranging from 1 to 10 Jackie Johnson Acute Pericarditis discussion. The pain is verbalized to be sharp in nature, worsens with deep breaths, is retrosternal, and is improved when “leaning forward”. In addition, she also indicates having had “flu like illness” within the past few days such as fever, rhinorrhea, and cough. She denies any additional medical history and is not taking any medication. Also, she denies any alcohol, tobacco, or drug use. Of note, she is reported to work as an Advertising Executive. Jackie Johnson Acute Pericarditis discussion

Upon physical examination findings she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination are notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Jackie Johnson Acute Pericarditis discussion Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal. Jackie Johnson Acute Pericarditis discussion

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Given the patients report and the physical examination obtained, factors aside from medical findings to keep in mind when moving forward are: A highly stressful job, her sex, her race, and her marital status, which may contribute to stress levels as well Jackie Johnson Acute Pericarditis discussion.

After assessment of the findings presented, J.J’s likely Diagnosis is Acute Pericarditis, which is an inflammation of the pericardium, caused by the sac’s layers becoming inflamed and possibly rubbing against the heart (American Heart Association, 2016). A client with acute pericarditis will complain of chest pain that worsens with deep breaths or while coughing when lying down and is relieved by positional changes, such as leaning forward or sitting up (Hammer & McPhee, 2014). Also, a clinical finding in patients with acute pericarditis is a high-pitched squeaking sound upon cardiac auscultation, which may be indicative of pericardial rub (Hammer & McPhee, 2014) Jackie Johnson Acute Pericarditis discussion. The presence of pericardial rub often indicates complications of pericarditis such as an increase in fluid between the layers of the pericardium which causes the rubbing between the pericardium and heart, pericardial effusion (Hammer & McPhee, 2014), this best explains the pathophysiological mechanism causing the chest pain for J.J currently.  J.J’s cardiac exam shows tachycardia, as evidenced by a heart rate of 105, with a three-component high pitched squeaking sound, which is a finding indicative of acute pericarditis, but may also be indicative of complications related to pericarditis (American Heart Association, 2016). Jackie Johnson Acute Pericarditis discussion

Causes of pericarditis include viral, bacterial, protozoal, and mycotic infections (Hammer & McPhee, 2014) or its cause can be idiopathic. Per J.J’s report of  “flu like illness for the past few days” which include fever, rhinorrhea, and cough lead me to believe that a likely cause of the pericarditis is a virus. The mild erythematous oropharynx, and shotty anterior cervical lymphadenopathy noted during the physical exam are also indicative of viral cause. Jackie Johnson Acute Pericarditis discussion

Though acute pericarditis is the likely diagnosis for J.J given her relatively healthy history, further assessment and diagnostic testing should be obtained to confirm and or rule out other cardiac related illnesses that may present with similar symptoms. In the case of J.J, the symptoms presented do not coincide with clinical manifestations exhibited in other cardiac related illnesses. Her blood pressure is within normal limits, her respirations are normal, O2 Sat is WNL, jugular veins are not distended, and is not experiencing dyspnea. The clinical findings exhibited: elevated heart rate, mild erythematous oropharynx, shotty anterior cervical lymphadenopathy, tachycardia with 3-component high pitched squeaking sound are all symptoms that point to pericarditis. However, we must also take into consideration that there are non-cardiac related conditions that can also present in the form of chest pain (Fass, R., & Achem, S.R, 2011). Jackie Johnson Acute Pericarditis discussion Psychological disorders such as panic, anxiety, and depression can also clinically manifest with chest pain (Huffman, J., Pollack, M., & Stern, T., 2002). Given J.J’s high demanding job, we can suspect that she experiences high levels of stress that can contribute to anxiety, but in order to further diagnose this, more information needs to be obtained Jackie Johnson Acute Pericarditis discussion.

Considering that, “Heart disease and stroke are the No. 1 killers in women, and affects African American women disproportionately, making diabetes, smoking, high blood pressure, high cholesterol, physical inactivity, obesity and a family history of heart disease all greatly prevalent among African-Americans and are major risk factors for heart disease” (American Heart Association, 2016), I would want to investigate further into family history, and monitoring of cholesterol as well as potential for hypertension. Jackie Johnson Acute Pericarditis discussion

In order to increase J.J’s prognosis, a thorough assessment should be completed including an ECG, Chest X-ray, echocardiogram, and obtaining labs for signs of inflammation (American Heart Association, 2016). In addition, perhaps also including cholesterol screening would be helpful collateral information to better treat J.J. Currently, her blood pressure appears to be within normal limits, but I would want to monitor this as well. Lastly, I’d also want to examine J.J’s psychological and mental status to rule out anxiety related disorders, which could have also contributed to her chest pain.

Acute Pericarditis has been known to clear up on its own with simple treatment (American Heart Association, 2016).  Treatment, however, will be dependent on the cause (American Heart Association, 2016). Upon discharge, the recommendation for J.J will likely be anti-inflammatory medication in higher doses than usual, such as Motrin, or Aleve in order to alleviate the pain, and rest (American Heart Association, 2016), since she has no other known medical history and is relatively young. She should follow up with a cardiologist to monitor for recurrenceJackie Johnson Acute Pericarditis discussion.

 

References:

American Heart Association (2016, March 31). Retrieved from

https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis

Fass, R., Achem, S.R. (2011).  Noncardiac Chest Pain: Epidemiology, Natural Course and            Pathogenesis.  Journal of Neurogastroenterology and Motility,17:110-

123.https://doi.org/10.5056/jnm.2011.17.2.110

Hammer, G., & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical                    medicine  (8th ed.). New York, NY: McGraw-Hill Medical.

Huffman, J., Pollack, M., & Stern, T. (2002). Panic Disorder and Chest Pain: Mechanisms,

Morbidity, and Management. Primary Care Companion to The Journal of Clinical

            Psychiatry, 4(2):54-62.doi: 10.4088/pcc.v04n0203 Jackie Johnson Acute Pericarditis discussion

Jackie Johnson Acute Pericarditis Discussion 2

Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” Jackie Johnson Acute Pericarditis discussion over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Jackie Johnson Acute Pericarditis discussion Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.

In this discussion:

  1. Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?
  2. Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?
  3. Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
  4. Identify the pathophysiologic mechanism for her chest pain. Jackie Johnson Acute Pericarditis discussion
  5. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Discussion 2 – Pleuritic Chest Pain

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Case: Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. Jackie Johnson Acute Pericarditis discussion On review of systems, she has noted a “flu-like illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination are notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal. Jackie Johnson Acute Pericarditis discussion

  1. Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?

Upon initial presentation, a clue that the chest pain may be pleuritic in nature is related to the symptoms the patient describes as sharp pain that increases while taking a deep breath, and the pain is located retrosternal with movement of the chest pain to the back. These are classic symptoms of pleuritic chest pain (Hammer & McPhee, 2019; Reamy, Williams, & Odom, 2017). Upon further examination with a repositioning test, the patient voices improvement of chest pain when leaning forward which validates that somatic nerves of the parietal pleura are sensitized with inflammation that is commonly seen in pleuritic chest pain. Further assessment of a “pericardial rub” (an audible high-pitched or squeaking noise as sticky inflammatory fluid in the pericardial sac moves between the visceral and parietal pericardial layers) lends another layer of confirmation, that the patient’s chest pain is pleuritic and possibly due to pericarditis because a pericardial rub is also found to be a classic sign used in developing a diagnosis of pericarditis (Gupta, 2019; Hammer & McPhee, 2019) Jackie Johnson Acute Pericarditis discussion.

  1. Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?

Pleuritic chest pain can be caused by other conditions. The most serious and life-threatening conditions such as pulmonary embolism, myocardial infarction, aortic dissection, pneumonia, and pneumothorax, have similar signs and symptoms, and diagnostic clinically reasoning can help the practitioner discern, contrast and compare between them quickly to anticipate and plan for life saving interventions. For example, approximately 5% to 21% of emergency department patients are found to have a pleuritic chest discomfort with a pulmonary embolism. In fact, 66% of patients experienced pleuritic chest pain which was associated with a pulmonary embolism (Reamy, Williams, & Odom, 2017, 306). On the other hand, sharp chest pain is usually not cardiac. Also, if you have a pretty good clue of the diagnosis, such as in this case, pericarditis, then you would want to consider the possible related complications such as pericardial effusion, constrictive pericarditis and cardiac tamponade. However, over 80% of pericarditis cases have good outcomes, so searching for other causes may not always be warranted (Imazio, 2020) Jackie Johnson Acute Pericarditis discussion.

It is important to look at other causes, associated signs and symptoms, and complete tests that can help you validate a definitive diagnosis. For instance, an EKG may show occasional ST elevation in pericarditis, whereas, in contrast, adjacent leads will show consistent ST elevation along with elevated cardiac enzymes in myocardial infarction. Jackie Johnson Acute Pericarditis discussion And a chest x-ray is often normal with myocardial infarction, but may show cardiomegaly in pericarditis (Reamy, Williams, & Odom, 2017, p. 310).

The working diagnoses, I would probably consider, after a through physical exam and history is pericarditis. Differential diagnoses of a new or old myocardial infarction,  pulmonary embolism, or pneumonia could possibly be considered. Diagnostic evidence such as a chest x-ray will help to identify the size of the heart, the condition of the pericardium, and the condition of the lungs which will aid in discerning a probable diagnosis.

  1. Provide and discuss what the most common causes of this disease are, and which is most likely in this patient? Jackie Johnson Acute Pericarditis discussion

The most common causes of  pericarditis is inflammation caused by infections from virus (primarily the coxsackievirus), bacteria, protozoal, and mycotic; collagen-vascular related diseases, such as systemic lupus erythematosus, rheumatoid arthritis; neoplasm; metabolic, such as renal failure; injury such as myocardial infarction, post myocardial infarction, and trauma; idiopathic in which the disease presents itself without a defining reason (Hammer & McPhee, 2019, p. 320). Since the patient has had recent flu symptoms and anterior cervical lymphadenopathy with symptoms classic for pericarditis, her condition is mostly likely caused by a viral infection Jackie Johnson Acute Pericarditis discussion.

  1. Identify the pathophysiologic mechanism for her chest pain.

Pericarditis is caused by inflammation of the pericardial sac. The inflammation builds up sticky fluid that grinds against the pericardial surfaces of the visceral and parietal surfaces. The inflammation will initiate growth of polymorphonuclear leukocytes, cause pus type accumulation, and buildup of fibrin material (Hammer & McPhee, 2019). There are no pain receptors in the visceral pleura; however, in response to inflammation, the parietal pleura’s pain receptors are stimulated, and the parietal pleurae and lateral hemidiaphragm can sensitize cutaneous nerves towards the surface of the skin. Swelling and inflammation to these innervated areas can cause increased pain such as with respiratory movement (Reamy, Williams, & Odom, 2017) Jackie Johnson Acute Pericarditis discussion.

  1. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Ms. Johnson is a young and currently working a successful job. It would be good to explore with Ms. Johnson her support system at home, and consider involving a significant other in the education related to her diagnosis and treatment plan. With an unremarkable work-up, discussing with Ms. Johnson home self-care options would probably be safe if she is agreeable to following the home care guidelines, and follow-up for re-evaluation as scheduled. Home therapy would possibly include activity restrictions to include no strenuous exercise, treatment regimen with NSAIDs and colchicine for one to two weeks. Jackie Johnson Acute Pericarditis discussion Follow-up with the patient via a phone conference in one week, and then a follow-up office visit in two weeks would be a good way to monitor if she is responding to the therapy (Imazio, 2020).

References:

Gupta, J. (2019, June). Cardiac Auscultation. Retrieved from https://www.merckmanuals.com/professional/cardiovascular-disorders/approach-to-the-cardiac-patient/cardiac-auscultation

Hammer, G. D., & McPhee, S. (2019). Pathophysiology of Disease: An Introduction to Clinical Medicine (8 ed.). New Youk: McGraw-Hill Education Medical. Jackie Johnson Acute Pericarditis discussion

Imazio, M. (2020, February 21). Acute pericarditis: Treatment and prognosis. Retrieved https://www.uptodate.com/contents/acute-pericarditis-treatment-and-prognosis

Reamy, B. V., Williams, P. M., & Odom, M. R. (2017, September 1). Pleuritic chest pain: Sorting through the differential diagnosis. American Family Physician, 306-312. Retrieved from https://www.aafp.org/afp/2017/0901/p306.html Jackie Johnson Acute Pericarditis discussion

N512 Advanced Pathophysiology Acute Pericarditis

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N512 Advanced Pathophysiology Acute Pericarditis

N512 Advanced Pathophysiology Acute Pericarditis

Jackie Johnson is described as a married 35-year-old African American female who has presented to the emergency room with: Chest pain, which she rates 8 out of 10 on a scale ranging from 1 to 10. The pain is verbalized to be sharp in nature, worsens with deep breaths, is retrosternal, and is improved when “leaning forward”. In addition, she also indicates having had “flu like illness” within the past few days such as fever, rhinorrhea, and cough. She denies any additional medical history and is not taking any medication. Also, she denies any alcohol, tobacco, or drug use. Of note, she is reported to work as an Advertising Executive. N512 Advanced Pathophysiology Acute Pericarditis.

Upon physical examination findings she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination are notable for clear mucus in the nasal passages and a mildly erythematous oropharynx N512 Advanced Pathophysiology Acute Pericarditis. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal. N512 Advanced Pathophysiology Acute Pericarditis

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Given the patients report and the physical examination obtained, factors aside from medical findings to keep in mind when moving forward are: A highly stressful job, her sex, her race, and her marital status, which may contribute to stress levels as well.

After assessment of the findings presented, J.J’s likely Diagnosis is Acute Pericarditis, which is an inflammation of the pericardium, caused by the sac’s layers becoming inflamed and possibly rubbing against the heart (American Heart Association, 2016). A client with acute pericarditis will complain of chest pain that worsens with deep breaths or while coughing when lying down and is relieved by positional changes, such as leaning forward or sitting up (Hammer & McPhee, 2019) N512 Advanced Pathophysiology Acute Pericarditis. Also, a clinical finding in patients with acute pericarditis is a high-pitched squeaking sound upon cardiac auscultation, which may be indicative of pericardial rub (Hammer & McPhee, 2019). The presence of pericardial rub often indicates complications of pericarditis such as an increase in fluid between the layers of the pericardium which causes the rubbing between the pericardium and heart, pericardial effusion (Hammer & McPhee, 2019), this best explains the pathophysiological mechanism causing the chest pain for J.J currently. N512 Advanced Pathophysiology Acute Pericarditis J.J’s cardiac exam shows tachycardia, as evidenced by a heart rate of 105, with a three-component high pitched squeaking sound, which is a finding indicative of acute pericarditis, but may also be indicative of complications related to pericarditis (American Heart Association, 2016).

Causes of pericarditis include viral, bacterial, protozoal, and mycotic infections (Hammer & McPhee, 2019) or its cause can be idiopathic. Per J.J’s report of  “flu like illness for the past few days” which include fever, rhinorrhea, and cough lead me to believe that a likely cause of the pericarditis is a virus. The mild erythematous oropharynx, and shotty anterior cervical lymphadenopathy noted during the physical exam are also indicative of viral cause.

Though acute pericarditis is the likely diagnosis for J.J given her relatively healthy history, further assessment and diagnostic testing should be obtained to confirm and or rule out other cardiac related illnesses that may present with similar symptoms. In the case of J.J, the symptoms presented do not coincide with clinical manifestations exhibited in other cardiac related illnesses N512 Advanced Pathophysiology Acute Pericarditis. Her blood pressure is within normal limits, her respirations are normal, O2 Sat is WNL, jugular veins are not distended, and is not experiencing dyspnea. The clinical findings exhibited: elevated heart rate, mild erythematous oropharynx, shotty anterior cervical lymphadenopathy, tachycardia with 3-component high pitched squeaking sound are all symptoms that point to pericarditis. However, we must also take into consideration that there are non-cardiac related conditions that can also present in the form of chest pain (Fass, R., & Achem, S.R, 2011).  Psychological disorders such as panic, anxiety, and depression can also clinically manifest with chest pain (Huffman, J., Pollack, M., & Stern, T., 2002). Given J.J’s high demanding job, we can suspect that she experiences high levels of stress that can contribute to anxiety, but in order to further diagnose this, more information needs to be obtained N512 Advanced Pathophysiology Acute Pericarditis.

Considering that, “Heart disease and stroke are the No. 1 killers in women, and affects African American women disproportionately, making diabetes, smoking, high blood pressure, high cholesterol, physical inactivity, obesity and a family history of heart disease all greatly prevalent among African-Americans and are major risk factors for heart disease” N512 Advanced Pathophysiology Acute Pericarditis (American Heart Association, 2016), I would want to investigate further into family history, and monitoring of cholesterol as well as potential for hypertension.

In order to increase J.J’s prognosis, a thorough assessment should be completed including an ECG, Chest X-ray, echocardiogram, and obtaining labs for signs of inflammation (American Heart Association, 2016). In addition, perhaps also including cholesterol screening would be helpful collateral information to better treat J.J. Currently, her blood pressure appears to be within normal limits, but I would want to monitor this as well. N512 Advanced Pathophysiology Acute Pericarditis Lastly, I’d also want to examine J.J’s psychological and mental status to rule out anxiety related disorders, which could have also contributed to her chest pain.

Acute Pericarditis has been known to clear up on its own with simple treatment (American Heart Association, 2016).  Treatment, however, will be dependent on the cause (American Heart Association, 2016). Upon discharge, the recommendation for J.J will likely be anti-inflammatory medication in higher doses than usual, such as Motrin, or Aleve in order to alleviate the pain, and rest (American Heart Association, 2016), since she has no other known medical history and is relatively young. She should follow up with a cardiologist to monitor for recurrence. N512 Advanced Pathophysiology Acute Pericarditis

 

References:

American Heart Association (2016, March 31). Retrieved from

https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis

Fass, R., Achem, S.R. (2011).  Noncardiac Chest Pain: Epidemiology, Natural Course and              Pathogenesis.  Journal of Neurogastroenterology and Motility,17:110-123.https://doi.org/10.5056/jnm.2011.17.2.110

Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine  (8t ed.). New York, NY: McGraw-Hill Medical.

Huffman, J., Pollack, M., & Stern, T. (2002). Panic Disorder and Chest Pain: Mechanisms,

Morbidity, and Management. Primary Care Companion to The Journal of Clinical

 Psychiatry, 4(2):54-62.doi: 10.4088/pcc.v04n0203 N512 Advanced Pathophysiology Acute Pericarditis

Discussion 2

Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature N512 Advanced Pathophysiology Acute Pericarditis. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal. N512 Advanced Pathophysiology Acute Pericarditis

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In this discussion:

  1. Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?
  2. Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?
  3. Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
  4. Identify the pathophysiologic mechanism for her chest pain.
  5. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.
  6. N512 Advanced Pathophysiology Acute Pericarditis

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. N512 Advanced Pathophysiology Acute Pericarditis

Acute Pericarditis Discussion Essay

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Acute Pericarditis Discussion Essay

Discussion 2

Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward Acute Pericarditis Discussion Essay. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Acute Pericarditis Discussion Essay Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal. Acute Pericarditis Discussion Essay

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In this discussion:

  1. Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?
  2. Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?
  3. Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
  4. Identify the pathophysiologic mechanism for her chest pain Acute Pericarditis Discussion Essay.
  5. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Discussion 2, Moule 2

1. The most likely diagnosis for Jackie Johnson is acute viral pericarditis. She presented to the ED with “flu-like illness”, with fever, nasal drainage, and cough. Given her neg. medical history and description of chest pain, this would also fit with viral pericarditis. Also, it was noted on auscultation, a three-component high-pitch squeaking sound, a friction rub, is a hallmark sign of pericarditis Acute Pericarditis Discussion Essay.

2. The differential diagnoses would include M.I., P.E., Pneumonia, COVID, and Aortic Dissection. Chest pain in a 35-year-old female would be worked up with a thorough physical exam, complete patient history, and diagnostic testing because the M.I., P.E., Pneumonia, COVID, and Aortic Dissection all can have chest pain as a presenting complaint. Acute Pericarditis Discussion Essay

3. Viral infections (especially infections with coxsackieviruses and echoviruses), and probably are responsible for many cases classified as idiopathic. (Norris, 2019).  Infections may be bacterial, fungal, or viral. Other causes can be Neoplasms, high dose radiation to the chest, uremia, hypersensitivity, or autoimmune diseases such as acute rheumatic fever (the most common cause of pericarditis in children), lupus, and rheumatoid arthritis. Causes may also include previous cardiac injury, post-M.I. or surgery, that leaves the pericardium intact but causes blood to leak into the pericardium. (Lippincott, 2005). Viral pericarditis is the most likely diagnosis. Acute Pericarditis Discussion Essay.

4. The chest pain is due to a result of pericardium inflammation. The inflammation of the adjacent pleura may account for the worsening pain with deep breathing and coughing. (Hammer & McPhee, 2019) Acute Pericarditis Discussion Essay. With prolonged inflammation, the pericardium can become fibrotic and scarred, with calcium deposits, and this, in turn, can lead incomplete filling of the ventricles  resulting in constrictive pericarditis (Hammer & McPhee, 2019)

5. Upon discharge from the ED or from an inpatient status, her plan of care should be close follow up with her primary MD or possibly cardiology, depending on labs, EKG, chest x-ray, echo, etc. She may possibly need education on stress management due to her job as an advertising executive. Instructions are given on a healthy diet and exercise. She will be on a short course of NSAIDs and possibly colchicine. If NSAIDs are ineffective and no infection exists, corticosteroids can be given. (Lippincott,2005). Her social support, we can assume is her husband, and I would stress healthy life habits for them as a couple. Acute Pericarditis Discussion Essay

References

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of Disease. New York: McGraw-Hill Education.

Lippincott, W. &. (2005). Handbook of Pathophysiology. Philadelphia: Wolters Kluwer.

Norris, T. L. (2019). Porth’s Pathophysiology Concepts of Altered States. Philadelphia: Wolters Kluwer. Acute Pericarditis Discussion Essay

NRNP 6531: Advanced Practice Care of Adults Across the Lifespan – Week 5 Knowledge Check Quiz

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NRNP 6531: Advanced Practice Care of Adults Across the Lifespan – Week 5 Knowledge Check Quiz

Question 1

  1. A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?
a. Inferior wall
b. Anterior wall
c. Apical wall
d. Lateral wall

1 points

Question 2

  1. Other than smoking cessation, which of the following slows the progression of COPD in smokers?
a. Making sure the environment is free of all pollutants
b. Eliminating all pets from the environment
c. Engaging in moderate to high levels of physical activity
d. Remaining indoors with air conditioning as much as possible

1 points

Question 3

  1. Which of the following is not a risk factor for coronary arterial insufficiency?
a. Hyperhomocysteinemia
b. Smoking
c. Genetic factors
d. Alcohol ingestion

1 points

Question 4

  9. Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?

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  11. Question 1

    1. A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory? NRNP 6531: Advanced Practice Care of Adults Across the Lifespan – Week 5 Knowledge Check Quiz
    a. Inferior wall
    b. Anterior wall
    c. Apical wall
    d. Lateral wall

     

  12. 1 points

    Question 2

    1. Other than smoking cessation, which of the following slows the progression of COPD in smokers?
    a. Making sure the environment is free of all pollutants
    b. Eliminating all pets from the environment
    c. Engaging in moderate to high levels of physical activity
    d. Remaining indoors with air conditioning as much as possible

     

    1 points

    Question 3

    1. Which of the following is not a risk factor for coronary arterial insufficiency?
    a. Hyperhomocysteinemia
    b. Smoking
    c. Genetic factors
    d. Alcohol ingestion

    1 points

    Question 4

    1. Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?
    a. It is not effective during an acute asthma attack.
    b. It may take 2 to 3 days to begin working.
    c. This drug works within 10 minutes.
    d. This drug may be used by patients 6 years and older.

    1 points

    Question 5

    1. Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure?
    a. Increase her Lisinopril to 20mg daily
    b. Add a thiazide diuretic to the Lisinopril 5mg daily
    c. Discontinue the Lisinopril and start a combination of ACE Inhibitor and calcium channel blocker
    d. Discontinue the Lisinopril and start a diuretic

    1 points

    Question 6

    1. What condition is associated with mucus production greater than 3 months per year for at least 2 consecutive years?
    a. Asthma
    b. Emphysema
    c. Chronic obstructive lung disease
    d. Chronic bronchitis

    1 points

    Question 7

    1. Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?
    a. Xanthines
    b. Antihistimines
    c. Steroids
    d. Anticholinergics

    1 points

    Question 8

    1. Which type of lung cancer has the poorest prognosis?
    a. Adenocarcinoma
    b. Epidermoid carcinoma
    c. Small cell carcinoma
    d. Large cell carcinoma

    1 points

    Question 9

    1. Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?
    a. Mild intermittent
    b. Mild persistent
    c. Moderate persistent

    1 points

    Question 10

    1. Which drug category contains the drugs that are the first line Gold standard therapy for COPD?
    a. Corticosteroids
    b. Inhaled beta-2 agonist bronchodilators
    c. Inhaled anticholinergic bronchodilators
    d. Xanthines

    1 points

    Question 11

    1. Which of the following best describes hypertrophic cardiomyopathy?
    a. A weakened and enlarged myocardium
    b. Poor ventricular filling and weakened myocardium
    c. Enlarged left ventricle and septum
    d. None of the above

    1 points

    Question 12

    1. Risk factors for acute arterial insufficiency include which of the following?
    a. Recent myocardial infarction
    b. Atrial fibrillation
    c. Atherosclerosis
    d. All of the above

    1 points

    Question 13

    1. A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?
    a. A long-acting bronchodilator
    b. An inhaled corticosteroid and cromolyn
    c. Theophylline and a short acting bronchodilator
    d. A bronchodilator PRN and an inhaled corticosteroid

    1 points

    Question 14

    1. Management of a patient with hypertension and an abdominal aortic aneurysm would include:
    a. computed tomography scan without contrast
    b. changing the patient’s BP medications
    c. referral to a cardiologist
    d. immediate cardiac catheterization

    1 points

    Question 15

    1. A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:
    a. Mitral regurgitation
    b. Systolic heart failure
    c. Cardiac myxoma
    d. Diastolic heart failure

    1 points

    Question 16

    1. A patient presents to the office with a blood pressure 142/80. This patient is classified as having:
    a. Normal blood pressure
    b. Prehypertension
    c. Stage 1 hypertension
    d. Stage 2 hypertension

    1 points

    Question 17

    1. Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?
    a. Chronic sinusitis
    b. Acute bronchitis
    c. Bacterial pneumonia
    d. Acute exacerbation of chronic bronchitis

    1 points

    Question 18

    1. The most common correlate(s) with chronic bronchitis and emphysema is(are):
    a. Familial and genetic factors
    b. Cigarette smoking
    c. Air pollution
    d. Occupational environment

    1 points

    Question 19

    1. Which of the following is not a goal of treatment for the patient with cystic fibrosis?
    a. Prevent intestinal obstruction
    b. Provide adequate nutrition
    c. Promote clearance of secretions
    d. Replace water-soluble vitamins

    1 points

    Question 20

    1. In order to decrease deaths from lung cancer:
    a. All smokers should be screened annually
    b. All patients should be screened annually
    c. Only high risk patients should be screened routinely
    d. Patients should be counseled to quit smoking
a. It is not effective during an acute asthma attack.
b. It may take 2 to 3 days to begin working.
c. This drug works within 10 minutes.
d. This drug may be used by patients 6 years and older.

1 points

Question 5

  1. Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure?
a. Increase her Lisinopril to 20mg daily
b. Add a thiazide diuretic to the Lisinopril 5mg daily
c. Discontinue the Lisinopril and start a combination of ACE Inhibitor and calcium channel blocker
d. Discontinue the Lisinopril and start a diuretic

1 points

Question 6

  1. What condition is associated with mucus production greater than 3 months per year for at least 2 consecutive years?
a. Asthma
b. Emphysema
c. Chronic obstructive lung disease
d. Chronic bronchitis

1 points

Question 7

  1. Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?
a. Xanthines
b. Antihistimines
c. Steroids
d. Anticholinergics

1 points

Question 8

  1. Which type of lung cancer has the poorest prognosis?
a. Adenocarcinoma
b. Epidermoid carcinoma
c. Small cell carcinoma
d. Large cell carcinoma

1 points

Question 9

  1. Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?
a. Mild intermittent
b. Mild persistent
c. Moderate persistent

1 points

Question 10

  1. Which drug category contains the drugs that are the first line Gold standard therapy for COPD?
a. Corticosteroids
b. Inhaled beta-2 agonist bronchodilators
c. Inhaled anticholinergic bronchodilators
d. Xanthines

1 points

Question 11

  1. Which of the following best describes hypertrophic cardiomyopathy?
a. A weakened and enlarged myocardium
b. Poor ventricular filling and weakened myocardium
c. Enlarged left ventricle and septum
d. None of the above

1 points

Question 12

  1. Risk factors for acute arterial insufficiency include which of the following?
a. Recent myocardial infarction
b. Atrial fibrillation
c. Atherosclerosis
d. All of the above

1 points

Question 13

  1. A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?
a. A long-acting bronchodilator
b. An inhaled corticosteroid and cromolyn
c. Theophylline and a short acting bronchodilator
d. A bronchodilator PRN and an inhaled corticosteroid

1 points

Question 14

  1. Management of a patient with hypertension and an abdominal aortic aneurysm would include:
a. computed tomography scan without contrast
b. changing the patient’s BP medications
c. referral to a cardiologist
d. immediate cardiac catheterization

1 points

Question 15

  1. A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:
a. Mitral regurgitation
b. Systolic heart failure
c. Cardiac myxoma
d. Diastolic heart failure

1 points

Question 16

  1. A patient presents to the office with a blood pressure 142/80. This patient is classified as having:
a. Normal blood pressure
b. Prehypertension
c. Stage 1 hypertension
d. Stage 2 hypertension

1 points

Question 17

  1. Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?
a. Chronic sinusitis
b. Acute bronchitis
c. Bacterial pneumonia
d. Acute exacerbation of chronic bronchitis

1 points

Question 18

  1. The most common correlate(s) with chronic bronchitis and emphysema is(are):
a. Familial and genetic factors
b. Cigarette smoking
c. Air pollution
d. Occupational environment

1 points

Question 19

  1. Which of the following is not a goal of treatment for the patient with cystic fibrosis?
a. Prevent intestinal obstruction
b. Provide adequate nutrition
c. Promote clearance of secretions
d. Replace water-soluble vitamins

1 points

Question 20

  1. In order to decrease deaths from lung cancer:
a. All smokers should be screened annually
b. All patients should be screened annually
c. Only high risk patients should be screened routinely
d. Patients should be counseled to quit smoking.

N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

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N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

Module 2 Overview

Introduction

In this module students will review the normal anatomy and physiology of the heart and analyze the pathophysiology and clinical manifestations of selected cardiovascular disorders, including arrhythmias, congestive heart failure, valvular heart disease, and coronary artery disease.

Learning Objectives

After completing this module, you will be able to:

  • Review normal physiology of the cardiovascular system
  • Explain pathophysiological alterations in the cardiac cycle.
  • Analyze the pathogenesis of alterations in heart function.
  • Summarize the major clinical manifestations and complications of alteration in heart functions
  • N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

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Reading & Resources

Read Chapters 10 In Hammer, G. & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education / Medical

Optional readings:

Lindsell, C. J., Anatharaman, V., Diercks, D., et al. (2006). The internet tracking registry of acute coronary syndrome: A multicenter registry of patients with suspicion of acute coronary syndromes reported using the standardized reporting guidelines for emergency department chest pain studies. Annals of Emergency Medicine, 48(6), 666-677. N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

Ringstrom, E., & Freedman, J. (2006). Approach to undifferentiated chest pain in the emergency department: A review of recent medical literature and published practice guidelines. Mt. Sinai Journal of Medicine, 73(2), 499-505.

Learning Activities

  • Discussion: Participate in Discussion 2.

Discussion 2

Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal. N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

In this discussion:

  1. Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?
  2. Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?
  3. Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
  4. Identify the pathophysiologic mechanism for her chest pain.
  5. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook. N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. N512 Advanced Pathophysiology Module Two: Cardiovascular Disease Across the Life Span

NURS – 6521N Advanced Pharmacology Midterm Exam

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NURS – 6521N Advanced Pharmacology Midterm Exam

Question 1

A 77-year-old man’s chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect? NURS – 6521N Advanced Pharmacology Midterm Exam

The man’s glomerular filtration rate and creatinine levels are within reference ranges.
The man’s heart rate is between 60 and 70 beats per minute with a regular rhythm.
The man’s potassium and sodium levels remain with reference ranges.
The man’s chest sounds are clear and his ankle edema is lessened. NURS – 6521N Advanced Pharmacology Midterm Exam

D

question 2

Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine?

The resident has not eaten breakfast because of a recent loss of appetite
The resident’s apical heart rate is 112 beats/minute with a regular rhythm
The resident had a fall during the night while transferring from her bed to her bathroom
The resident received her annual influenza vaccination the previous day

B

 

 

 

 

Question 3

To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic patient, as the patient regains consciousness, the nurse should

administer calcium supplements.
position the patient in the side-lying position.
administer carbohydrates.
monitor for nausea and vomiting. 

NURS – 6521N Advanced Pharmacology Midterm Exam

C

 

 

 

 

Question 4

Which statement is FALSE regarding the treatment of hyperthyroidism?

Long-acting beta-blocking agents are given as adjunctive therapy until Propulthiouracil (PTU) or methimazole (Tapazole) restores the patient to euthyroid
Methimazole (Tapazole) is the drug of choice for pregnant or lactating females.
Propylthiouracil (PTU) reduces peripheral conversion of T4 to the more potent T3
Since methimazole (Tapazole) is stronger than Propylthiouracil (PTU), Methimazole should be initiated at 15 mg/day compared to 300 mg/day for Propylthiouracil for treatment of mild disease

D

Question 5

A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient’s medication regimen. Which of the patient’s medications should prompt the nurse to teach her to avoid drinking grapefruit juice?

Atorvastatin (Lipitor)
Rabeprazole (Aciphex)
Vitamin D
Citalopram (Celexa)

A

 

 

 

 

Question 6

A 65-year-old male presents with a history of worsening urinary urgency, frequency, and hesitancy. He also tells you that he has to “push really hard” to urinate and that his urine dribbles a little after he is done urinating. What medication should be avoided NURS – 6521N Advanced Pharmacology Midterm Exam

 

paroxetine
ipratropium inhaler
omeprazole
clonidine

A

 

 

 

uestion 7

A 39 y/o female is diagnosed with Graves disease.  She also has a small goiter =.  Her symptoms are not deemed to be severe and propylthiouracil is prescribed.  Whare is the most serious potential adverse effect of this medication?

Hypocalcemia
Renal Failure
Agranulocytosis
Hematouria

C

 

 

uestion 10

Which of the following patients is most likely to benefit from the administration of an adrenergic agonist?

A man who is in cardiogenic shock following a myocardial infarction
A man who has a diagnosis of primary hypertension 

NURS – 6521N Advanced Pharmacology Midterm Exam
A woman who has been admitted with a suspected ischemic stroke
A woman who is in labor and may require a caesarean section

A

 

Question 11

A male patient who is hypertensive takes Hydrochlorothiazide for his blood pressure . He  presents with red, painful swelling of the great toe. In addition to treating gout, you recognize that you may need to:

Increase his HCTZ
Order laboratory studies for diabetes
Change his thiazide antihypertensive medication
Advise him to lose weight

C

Question 12

A patient has been prescribed a drug that can be self-administered at home. NURS – 6521N Advanced Pharmacology Midterm Exam. Which of the following would be the most important information for the nurse to relate to the patient concerning self-administration of a drug? NURS – 6521N Advanced Pharmacology Midterm Exam

Where to purchase the medication
The cost of the drug
The therapeutic effects and possible adverse effects
The pharmacokinetics of the drug

C

Question 13

A 79-year-old woman who takes several medications for a variety of chronic health problems has been prescribed an oral antiplatelet aggregator that is to be taken once daily. The nurse has encouraged the woman to take the pill at the same time of day that she takes some of her other medications. What is the most likely rationale for the nurse’s advice?

Integrating the new drug into the patient’s existing schedule promotes adherence.
Combining a new drug with one or more existing drugs mitigates the risk of adverse effects.
Taking several drugs at one time maximizes recovery time for the liver and kidneys.
Rapid drug clearance fostered when a patient is able to minimize the number of drug administration times.

A

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Question 14

A Nurse Practitioner is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. NURS – 6521N Advanced Pharmacology Midterm Exam. The Nurse Practitioner suspects that the change in the effectiveness of the drug is related to

the impact of the placebo effect on the patient’s response.
the accumulative effect of the drug if it has been taken for many years.
the impact of the warmer climate on the patient’s physical state.
problems with patient compliance with the drug regimen due to the move.

C

 

 

 

 

Question 15

A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be

liquid.
lozenge.
tablet.
suppository.

D

 

 

 

Question 16

A patient with unstable angina pectoris who is NOT controlled with a nitrate would likely benefit most from the addition of:

1. Sodium channel blocker
2. Beta blocker
3. Cardiac glycoside
4. Either 1 or 2

C

 

Question 17

When prescribing an antihypertensive medication for a type 2 diabetic patient, the drug classifications that would tend to reduce insulin sensitivity are:

 Diuretics and calcium channel blockers.
Diuretics and beta blockers.
Calcium channel blockers and ACE inhibitors.
Alpha blockers and ACE inhibitors. NURS – 6521N Advanced Pharmacology Midterm Exam

B

 

 

 

 

Question 18

A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to

crush the tablet before swallowing.
swallow the tablet whole. NURS – 6521N Advanced Pharmacology Midterm Exam
swallow the tablet with milk or food.
avoid drinking milk for 3 hours after swallowing the tablet.

C

 

 

 

Question 19

A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain?

Call the physician
Ask the patient to lie back and try to relax
Have the patient swallow a tablet every 5 minutes for 15 minutes
Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided

D

 

 

 

Question 20

After a recent history of shortness of breath that has become increasingly severe, a woman has been prescribed ipratropium by MDI while she undergoes a diagnostic workup. What patient teaching should the nurse provide to this patient?

“Make sure that you take this at the scheduled times, regardless of whether you feel short of breath.”
“Most people find that ipratropium cures their lung disease within a few months.”
“You should think of this as an ’emergency drug’, and it should only be used when you experience symptoms.”
“It’s important that you perform deep breathing exercises before and after taking ipratropium.”

 

 

Question 77

A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man’s most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man’s serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings?

The man may be experiencing a paradoxical effect of aspirin
The man may be allergic to aspirin
The man may be experiencing liver toxicity from the aspirin
The man may be experiencing nephrotoxic effects of aspirin

D

 

 

Question 78

A patient receives 25 units of NPH insulin at 7.AM. NURS – 6521N Advanced Pharmacology Midterm Exam. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?

After breakfast
Before lunch
Late afternoon
Bedtime

C

 

 

estion 79

A patient is recovering from an acute episode of thrombophlebitis and is being treated with warfarin (Coumadin) 5 mg PO daily. In reviewing medication information, the Nurse Practitioner would include what information in their teaching?

Maintain close watch on Intake and Output
Do not take a multivitamin supplement
Limit dairy products
Aerobic exercises are the most effective

B

 

 

 

 

 

estion 80

A 47-year-old woman has been diagnosed with open-angle glaucoma. Pilocarpine drops are prescribed. The nurse’s assessment reveals that the patient has worn soft contact lenses for 15 years. The nurse will instruct the patient to

apply the contact lenses and wait 5 minutes before applying the drops.
remove the contact lenses before applying the drops.
apply the drops directly on the contact lenses.
stop wearing the contact lenses during the pilocarpine therapy. NURS – 6521N Advanced Pharmacology Midterm Exam

B

 

 

 

ion 82

A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his “puffers”. In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to

permanent liver damage.
rebound bronchoconstriction.
community-acquired pneumonia.
severe anticholinergic effects.

B

 

stion 81

A nurse practitioner understands when prescribing a medication that there are certain questions to address. Check all that apply.

Is there a need for the drug in treating the presenting problem?
Is this the best drug for the presenting problem?
Can the patient take the prescribed drug?
None of the above.

A

B

C

 

 

 

 

Question 83

A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient’s subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education NURS – 6521N Advanced Pharmacology Midterm Exam. What should the nurse teach the patient about her new medication?

“By reducing the amount of fluid that your body contains, digoxin will make it easier for your heart to pump.”
“This will lessen the workload of your heart by reducing your blood pressure.”
“Most patients see their heart failure resolve in 2 to 4 months after they begin taking digoxin.”
“This drug won’t cure your disease, but it will help you be able to exercise more and be more comfortable.”

D

 

 

 

 

 

 

Question 84

A Nurse Practitioner is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which of the following actions should the Nurse Practitioner take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment?

Avoid OTC antacids for the duration of treatment
Advocate for intravenous, rather than oral, administration
Teach the patient strategies for dealing with headaches
Carefully assess the patient for infections

D

 

 

Question 85

A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by

blocking adrenergic receptors and producing antisympathetic effects.
inhibiting the movement of calcium ions across the cardiac muscle cell membrane.
decreasing sodium and potassium conduction.
weakening diastolic depolarization and the action potential duration.

B

 

 

 

Question 86

The APRN would use what class of medication to manage COPD?

 

Mucolytic agents
Methylxanthine derivatives
Anticholinergic agents
Short-acting and long acting inhaled beta2 agonists

D

 

Question 87

A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of

an adrenergic antagonist.
an adrenergic agonist.
a cardiotonic.
a neurotransmitter.

A

 

 

 

 

Question 88

The Nurse Practitioner is treating a patient that takes frequent doses of antacids for his heartburn and is also taking an enteric coded aspirin.  What instructions should be provided to the patient?

The aspirin is less effective when taken with an antacid so you need to increase the dose.
The antacid destroys the aspirin so you should stop taking any antacids
The medications should be taken at least 2 hours apart. NURS – 6521N Advanced Pharmacology Midterm Exam
There is no effect of the antacid on the aspirin so they can be taken when it is convenient for you

C

 

 

 

Question 94

A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which of the following is an appropriate response by the nurse?

“Sure, you may take an antacid with ranitidine.”
“No, the two drugs will work against each other.”
“Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine.”
“I wouldn’t advise it. You may experience severe constipation.”

B

 

 

 

 

Question 95

Mr. Contreras is a 64-year-old patient with Type 2 diabetes. He has recently been diagnosed with hypertension. Which antihypertensive drug is the recommended choice to treat hypertension in patients with diabetes?

Diuretics
Beta Blocker
Calcium Channel Blocker
ACE Inhibitor

D

 

 

 

 

 

Question 96

A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an expectorant). What special instructions should the nurse include in the patient teaching for this situation?

Wash hands before and after taking the medicine
Keep track of any gastrointestinal tract infections
Monitor glucose levels closely
Note the time the medicine is taken each day

C

 

 

 

 

 

Question 97

A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is NURS – 6521N Advanced Pharmacology Midterm Exam

headache.
irritability.
dry mouth.
heart palpitations.

A

 

 

 

 

 

 

 

Question 98

A Nurse Practitioner is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following?

The amount of the drug that must be given to produce a particular response
How well a drug produces its desired effect
A drug’s strength of attraction for a receptor site
A drug’s ability to stimulate its receptor

B

 

 

 

 

Question 99

The APRN is seeing Mrs. Smith, age 77, who is here for follow up of hypertension, dyslipidemia, and depression.  What should you consider during her follow-up?

 

Changes in lean body mass and fluids have little effect on drug serum concentrations
No alteration in dosing is required with low albumin levels and protein bound drugs
The effects of cardiovascular and CNS medications are predictable in older adults
Age-related changes in renal function are the main cause of adverse drug reactions

D

 

 

 

 

Question 100

The APRN should educate a diabetic patient that beta blockers may mask the signs and symptoms of

insulin resistance
insulin sensitivity
hypoglycemia
hyperglycemia

NURS – 6521N Advanced Pharmacology Midterm Exam