NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Week 1 Discussion: Building a Health History

Effective communication is vital to constructing an accurate and detailed patient history. Many factors, including age, gender, ethnicity, and environmental setting influence a patient’s health or illness. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.

ORDER NOW FOR A CUSTOMIZED ACADEMIC PAPER

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following new patients:

76-year-old Black/African-American male with disabilities living in an urban setting
Adolescent Hispanic/Latino boy living in a middle-class suburb
55-year-old Asian female living in a high-density poverty housing complex
Pre-school aged white female living in a rural community
16-year-old white pregnant teenager living in an inner-city neighborhood

To prepare:

With the information presented in Chapter 1 in mind, consider the following:
How would your communication and interview techniques for building a health history differ with each patient?
How might you target your questions for building a health history based on the patient’s age, gender, ethnicity, or environment?
What risk assessment instruments would be appropriate to use with each patient?
What questions would you ask each patient to assess his or her health risks?
Select one patient from the list above on which to focus for this Discussion.
Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
Select one of the risk assessment instruments presented in Chapter 1 or Chapter 26 of the course text, or another tool with which you are familiar, related to your selected patient.
Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

By Day 3

Post a description of the interview and communication techniques you would use with your selected patient. Explain why you would use these techniques.Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.
Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected a different patient than you, using one or more of the following approaches:
Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
Suggest additional health-related risks that might be considered.
Validate an idea with your own experience and additional research.

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Week 1 Quiz

Question 1

Drawing of stick figures is most useful to:

Question 2

Mr. F. is speaking with you, the health care provider, about his respiratory problem. Mr. F. says, I ve had this cough for 3 days, and it s getting worse. You reply, Tell me more about your cough. Mr. F. states, I wish I could tell you more. That s why I m here. You tell me what s wrong! Which caregiver response would be most appropriate for enhancing communication?

Question 3

During the course of the interview you should:

Question 4

Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?

Question 5

Constitutional symptoms in the ROS refer to:

Question 6

A detailed description of the symptoms related to the chief complaint is presented in the:

Question 7

Which of the following is not a characteristic of the plan portion of the problem-oriented medical record?

Question 8

When recording assessments during the construction of the problem-oriented medical record, the examiner should:

Question 9

Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the:

Question 10

During a history-taking session, Mr. B. appears to be avoiding certain questions. He keeps looking out the window. What should the caregiver do?

Question 11

Mary Jane has brought in her 16-year-old son, Kyle. She states that he has been sleeping more, doesn t hang around his friends, and recently his girlfriend broke up with him. Your most immediate question is to ask Kyle:

Question 12

You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be:

Question 13

J.M. has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) _____ history.

Question 14

A tool used to screen adolescents for alcoholism is the:

Question 15

Ms. S. reports that she is concerned about her loss of appetite. During the history, you learn that her last child recently moved out of her house to go to college. Rather than infer the cause of Ms. S. s loss of appetite, it would be better to:

Question 16

Subjective and symptomatic data are:

Question 17

Which of the following is an effective adjunct to document location of findings during recording of physical examinations?

Question 18

When taking a history, you should:

Question 19

Which question would be considered a leading question?

Question 20

Which of the following is considered an IADL but not an ADL?

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs – NURS 6512 Week 2 Discussion

NURS 6512 DQ1 Assessment Tools and Diagnostic Tests

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to interpret the results accurately.

In this Discussion, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values.

To prepare:

Review this week’s Learning Resources, and consider the factors that impact the validity and reliability of various assessment tools and diagnostic tests.
Select one of the following assessment tools or diagnostic tests to explore for the purposes of this Discussion:
Mammogram
Physical tests for sore throat (inspecting the throat, palpating the head and neck lymph nodes, listening to breath sounds)
Prostate-specific antigen (PSA) test
Dix-Hallpike test
Body-mass index (BMI) using waist circumference for adults
Search the Walden Library and credible sources for resources explaining the tool or test you selected. What is its purpose, how is it conducted, and what information does it gather?
Examine the literature and resources you located for information about the validity and reliability of the test or tool you selected. What issues with sensitivity, specificity, and predictive values are related to the test or tool?
Are there any controversies or issues related to any of these tests or tools?
Consider any ethical dilemmas that could arise by using these tests or tools.

By Day 3

Post a description of how the assessment tool or diagnostic test you selected is used in health care. Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.
Read a selection of your colleagues’ responses.

By Day 6

Respond to at least one of your colleagues who selected a different tool or test than you, using one or more of the following approaches:

Critique your colleague’s evaluation of the validity and reliability of the tool or test selected.
Suggest alternative or additional tools or tests that should be considered when gathering information about specific conditions or symptoms.

ORDER NOW FOR A CUSTOMIZED ACADEMIC PAPER

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 DQ2: Diversity and Health Assessments

In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds.

Case 1

Subjective Data

CC: “I came for my annual physical exam, but do not want to be a burden to my daughter.”

History of Present Illness (HPI): At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs.

PMH: hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis

PSH: S/P cholecystectomy

Drug Hx:

Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and cipro 100mg daily.

Review of Systems (ROS)

General: + weight loss of 25 lbs over the past year; no recent fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT): no changes in vision or hearing, no difficulty chewing or swallowing.

Neck: no pain or injury

Respiratory:

CV:

GI:

GU: no urinary hesitancy or change in urine stream

Integument: multiple bruises on his upper arms and back.

MS/Neuro: + falls x 2 within the last 6 months; no syncopal episodes or dizziness

Psych:

Objective Data

PE: B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous.

Lungs: CTA AP&L

Cor: S1S2 without rub or gallop

Abd: benign, normoactive bowel sounds x 4

Ext: no cyanosis, clubbing or edema

Integument: multiple bruises in different stages of healing – on his upper arms and back.

Neuro: No obvious deformities, CN grossly intact II-XII

Case 2

Subjective Data

CC: “I am here for my annual physical exam and have been having vaginal discharge.”

History of Present Illness (HPI): 32-year-old pregnant lesbian – her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank.

Drug Hx:

Current Medications: prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion

Family Hx: She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.

Review of Systems (ROS)

General: no fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT):

Neck: no pain or injury

Respiratory:

CV:

GI:

GU:

Integument: multiple piercings, and tattoos. Old scars related to “cutting”.

Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Objective Data

PE: B/P 128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, ornasopharynx clear, good dentition. Piercing in her right nostril and lower lip.

Lungs: CTA AP&L

Cor: S1S2 without rub or gallop

Abd: benign, normoactive bowel sounds x 4

GU: external genitalia intact, no lesions or masses. White copious discharge with an amine odor; no cervical motion tenderness; adenxa intact.

Ext: no cyanosis, clubbing or edema

Integument: intact without lesions masses or rashes.

Neuro: No obvious deficits and CN grossly intact II-XII

Case 3

Subjective Data

CC: “Annual physical exam”

History of Present Illness (HPI): 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle.

Drug Hx:

Current medication – denied

Allergies: no allergies to food or medications.

Family history: is very positive for diabetes, hypertension, and alcoholism.

Review of Systems (ROS)

General: no recent weight gains of losses, fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT):

Neck:

Respiratory:

CV: no chest discomfort or palpitations

GI:

GU:

Integument: history of eczema – not active

MS/Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Psych:

Objective Data

PE: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6

General: 23 year old male appears well developed and well nourished. He is anxious – pacing in the room and fidgeting, but in no acute distress.

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, ornasopharynx clear, poor dentition – multiple carries.

Lungs: CTA AP&L

Cor: S1S2, +II/VI holosystolic murmur; without rub or gallop

Abd: benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.

Ext: no cyanosis, clubbing or edema

Integument: intact without lesions masses or rashes.

Neuro: No obvious deficits and CN grossly intact II-XII

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
Select one of the three case studies. Reflect on the provided patient information.
Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Read a selection of your colleagues’ responses.

By Day 6

Respond on or before Day 6 to at leastone of your colleagues who selected a different patient than you, using one or more of the following approaches:

Suggest additional socioeconomic, spiritual, lifestyle, and other cultural factors related to the patient.
Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Week 2 Quiz

Question 1

When percussing, a dull tone is expected to be heard over:

Question 2

Which technique should be used to stabilize the stethoscope during auscultation?

Question 3

The degree of percussion tone is determined by the density of the medium through which the sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone?

Question 4

Which of the following describes a physical, not a cultural, differentiator?

Question 5

Your new patient is a 40-year-old Middle Eastern man with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:

Question 6

Which statement is true regarding the impoverished?

Question 7

To perform a deep tendon reflex measurement, you should:

Question 8

In terms of cultural communication differences, Americans are more likely to _____ than are other groups of patients.

Question 9

Underestimation of blood pressure will occur if the blood pressure cuff s bladder:

Question 10

Guidelines for Standard Precautions indicate that mask and eye protection or a face mask should be worn while performing:

Question 11

A patient in the emergency department has a concussion to the head. You suspect the patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient?

Question 12

A nonambulatory 80-year-old male patient tells the female nurse that he feels like he is having drainage from his rectum. Which initial nursing action is appropriate?

Question 13

For a woman with a small vaginal opening, the examiner should use a _____ speculum.

Question 14

Which statement is true regarding the relationship of physical characteristics and culture?

Question 15

You are performing a vaginal examination for a patient with a history of spina bifida. As you insert the metal speculum, the patient suddenly feels nauseated and is sweating, and her skin turns blotchy. What is your most immediate reaction to this situation?

Question 16

The infant should be placed in which position to have his or her height or length measured?

Question 17

Which question has the most potential for exploring a patient s cultural beliefs related to a health problem?

Question 18

Expected normal percussion tones include:

Question 19

A naturalistic or holistic approach to health care often assumes:

Question 20

Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is likely to be most problematic for the hypertensive patient of which group?

ORDER NOW FOR A CUSTOMIZED ACADEMIC PAPER

NURS 6512 Week 3 Discussion: Health Assessment of Children’s Weight

Body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.

For this Discussion, you will consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To prepare:

Consider the following examples of pediatric patients and their families:

Overweight 5-year-old boy with overweight parents
Slightly overweight 10-year-old girl with parents of normal weight
5-year-old girl of normal weight with obese parents
Slightly underweight 8-year-old boy with parents of normal weight
Severely underweight 12-year-old girl with underweight parents
Select one of the examples on which to focus for this Discussion. What health issues and risks may be relevant to the child you selected?
Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

By Day 3

Post an explanation of the health issues and risks that are relevant to the child you selected. Describe additional information you would need in order to further assess his or her weight-related health. Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information. Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.
Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on 2 different days who selected a different example than you, using one or more of the following approaches:

Suggest additional health risks or issues that could be relevant to the child.
Critique your colleagues’ questions, and suggest how the parents or caregivers might interpret these questions. Provide alternate or additional questions.
Suggest an additional strategy for gathering patient information or promoting proactivity.

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Week 3 Quiz

Question 1

Milestone achievements are data most likely to appear in the history of:

Question 2

In clinical practice, the Ballard Assessment Tool is used to assess a newborn’s:

Question 3

At what age does peak height growth velocity occur in boys?

Question 4

Which breast Tanner stage corresponds to a secondary areola mound development above the breast?

Question 5

Gender-specific skeletal differences first occur during:

Question 6

A detailed description of the symptoms related to the chief complaint is presented in the:

Question 7

Subjective and symptomatic data are:

Question 8

Which of the following is an example of a problem requiring recording on the patient s problem list?

Question 9

Deficiency of which micronutrient is implicated in osteoporosis?

Question 10

When recording assessments during the construction of the problem-oriented medical record, the examiner should:

Question 11

In children 3 to 18 years of age, the formula age + 5 g should be used to determine _____ needs.

Question 12

Which medication is frequently associated with weight gain?

Question 13

Which of the following is an effective adjunct to document location of findings during recording of physical examinations?

Question 14

A major risk factor for developing an eating disorder is having:

Question 15

Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?

Question 16

An anorexia patient is different from the bulimic patient because of the following characteristics:

Question 17

You are advising a patient concerning his targeted low-density lipoprotein cholesterol (LDL-C) level. The patient currently smokes and has medication-controlled hypertension. You should tell this patient that he should modify his diet and exercise in order to meet the target LDL-C of <_____ mg/dL.

Question 18

The patient s perceived disabilities and functional limitations are recorded in the:

Question 19

During the course of the interview you should:

Question 20

Which B vitamin is deficient in patients with pernicious anemia? NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Week 4 Discussion: Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Discussion, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

Note: Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance.Remember that not all comprehensive SOAP data are included in every patient case.

To prepare:

Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion.
Consider the abnormal physical characteristics you observe in the graphics you selected. How would you describe the characteristics using clinical terminologies?
Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
Consider which of the conditions is most likely to be the correct diagnosis, and why.

By Day 3

Post a description of the two graphics you selected (identify each graphic by number). Use clinical terminologies to explain the physical characteristics featured in each graphic. Formulate a differential diagnosis of three to five possible conditions for each. Determine which is most likely to be the correct diagnosis, and explain your reasoning.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days. Make sure that you respond to colleagues who selected at least one graphic that is different from the ones you selected. For each, address all of the following:

Critique your colleague’s clinical description of the physical characteristics of each.
Suggest an additional possible condition for each graphic, and explain your reasoning.
Provide an alternative correct diagnosis, and explain your reasoning.
Validate an idea with your own experience and additional research.

Chapter 28, “Rashes and Skin Lesions”
This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.

Note: Download and use the Student Checklist and the Key Points when assessing the skin, hair, and nails in this Week’s Lab Assignment.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Student checklist. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Week 4 Quiz

Question 1

Which of the following is a noncandidal fungal infection?

Question 2

Which of the following is an “ABCD” characteristic of malignant melanoma?

Question 3

A 5-year-old child presents with discrete vesicles on an erythematous base (dew drops on a rose petal appearance) that began near her scalp and are spreading to the trunk. The child has a low-grade fever and feels tired. What is the nurse’s next action?

Question 4

Cherry angiomas are a common finding in:

Question 5

The skin repairs surface wounds by:

Question 6

As part of your health promotion education for a new patient, you explain that the risk factors for skin cancer include:

Question 7

Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4 ´ 3-cm, rough, elevated area of psoriasis. This is an example of a:

Question 8

Small, minute bruises are called:

Question 9

A 17-year-old student complains of a “rash for 3 days.” You note pale, erythematous oval plaques over the trunk. They have fine scales and are arranged in a fernlike pattern with parallel alignment. What is the nurse’s next action?

Question 10

A 29-year-old white woman appears jaundiced. An etiology of liver disease has been excluded. What history questions should the nurse ask?

Question 11

A simian line seen in the palm of a small child may imply:

Question 12

The nurse inspects an annular lesion. What type of additional lighting source should be used for further assessment?

Question 13

The characteristic that best differentiates psoriasis from other skin abnormalities is the:

Question 14

Age spots are also called:

Question 15

The secretory activity of the sebaceous glands is stimulated by:

Question 16

A Dennie-Morgan fold is probably caused by:

Question 17

The most common cutaneous neoplasm is:

Question 18

Sally came to your family practice clinic 24 hours after she lacerated her foot on an oyster shell. The wound is 4cm in length, shallow, and is on the sole of her foot. There is a small amount of bleeding on the dressing. She asks you to suture it closed because it keeps leaking blood. What is the best response?

Question 19

The rationale for suturing wounds includes:

Question 20

Wound infections are often cause by all of the following organisms except:

NURS 6512 Week 5 Discussion: Assessing the Ears, Nose, and Throat

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.

In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

Note: By Day 1 of this week, your instructor will have assigned you to one of the following case studies to review for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

Case 1: Nose-Focused Exam

Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he’s taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.

Case 2: Focused Throat Exam

Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn’t take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily’s. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn’t sound congested.

Case 3: Focused Ear Exam

Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has complained to her about a mild earache for the past two days. His grandmother believes that he feels warm but did not verify this with a thermometer. James states that the pain was worse while he was falling asleep and that it was harder for him to hear. When you begin basic assessments, you notice that James has a prominent tan. When you ask him how he’s been spending his summer, James responds that he’s been spending a lot of time in the pool.

To prepare:

With regard to the case study you were assigned:

Review this week’s Learning Resources and consider the insights they provide.
Consider what history would be necessary to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least 10 possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying the number of the case study you were assigned.

By Day 3

Post a description of the health history you would need to collect from the patient in the case study to which you were assigned. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition and justify your reasoning.

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Week 5 Quiz

Question 1

Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence?

Question 2

Self-analysis assists providers in giving proper context to:

Question 3

You are using a pneumonic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to:

Question 4

Which of the following is true regarding cephalhematoma?

Question 5

The thyroid gland should:

Question 6

To approximate vocal frequencies, which tuning fork should be used to assess hearing?

Question 7

Expected physical changes associated with older adults include:

Question 8

L.G., age 58, has a chief complaint of diffuse, crampy abdominal pain, which has progressed to a severity scale of 7 out of 10. He is afebrile and denies nausea and vomiting and diarrhea. Family history is positive for intestinal polyps, diabetes mellitus, and Alzheimer disease. His past medical history is positive for kidney stones, gastroesophageal reflux disease, and hypercholesterolemia. Physical examination is positive for guarding and tenderness in the epigastric region but is otherwise normal. In an effort to confirm your hypothesis, you should schedule a(n):

Question 9

In the presence of otitis externa, tympanic membrane perforation, or myringotomy tubes you should:

Question 10

When hearing is evaluated, which cranial nerve is being tested?

Question 11

A newborn whose serum bilirubin is greater than 20 mg/100 mL risks later:

Question 12

Which of the following is not a component of a management plan?

Question 13

Which of the following recreational drugs is commonly associated with nasal septum perforation?

Question 14

For best results, an otoscopic and oral examination in a child should be:

Question 15

A patient has come in with a chief complaint of facial pain and “sinus issues.” Transillumination of the right sinus produces no light. You consulted your preceptor to order a sinus x-ray and she agreed. Which of the following findings on x-ray would support your diagnosis of sinusitis?

Question 16

An increased level of lysozyme in the tears will occur normally during which life stage?

Question 17

Xanthelasma may suggest that the patient has an abnormality of:

Question 18

When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient to respond by:

Question 19

You are attempting to examine the eyes of a newborn. To facilitate eye opening, you would first:

Question 20

Cotton wool spots are most closely associated with:

NURS 6512 Week 6 Discussion: Assessing the Heart, Lungs, and Peripheral Vascular System

Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?

In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.

In this Discussion, you will consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted.

Note: By Day 1 of this week, your Instructor will have assigned you to one of the video case studies in this week’s Learning Resources titled Advanced health assessment and diagnostic reasoning. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance.Remember that not all comprehensive SOAP data are included in every patient case.

To prepare:

With regard to the case study you were assigned:

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

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 6”) with “Review of Case Study” identifying the number of the case study you were assigned.

By Day 3

Post a description of the health history you would need to collect from the patient in the case study you were assigned. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Read a selection of your colleagues’ responses.

By Day 6

ORDER NOW FOR A CUSTOMIZED ACADEMIC PAPER

NURS 6512 Week 6 Quiz

Question 1

On a CXR, which of the following is true of the diaphragm?

Question 2

The most helpful finding in determining left-sided heart failure is:

Question 3

Respiratory effort usually exhibited by the patient with cerebral brain damage is called:

Question 4

A third heart sound is created by:

Question 5

Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the:

Question 6

The amplitude of pulses is recorded on a(n):

Question 7

Chronic obstructive pulmonary disease, pericarditis, and pericardial effusion are most often associated with:

Question 8

A bounding pulse in an infant may be associated with:

Question 9

Conduction system impairment should be suspected if an irregular heartbeat is:

Question 10

The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the:

Question 11

In infants or small children, a capillary refill time of 4 seconds:

Question 12

Thrombosis of a leg vein should be suspected if the patient feels calf pain:

Question 13

A 34-year-old man is being seen for complaints of dull pain between the shoulder blades that is more intense with deep breathing and coughing. Upon auscultation of the chest you suspect that you will hear:

Question 14

Heart position can vary depending on body habitus. In a short, stocky individual, you would expect the heart to be located:

Question 15

The level at which the jugular venous pulse is visible gives an indication of:

Question 16

Which of the following statements is most accurate in describing hepatic jugular reflux?

Question 17

Purkinje fibers are located in the:

Question 18

As you take vital signs on Mr. B., age 78, you note that his respirations are 40 per minute. He has been resting and his mucosa is pink. Concerning Mr. B. s respirations, you would:

Question 19

Systolic hypertension in the adult is generally defined as pressure in excess of:

Question 20

In barrel chest, the ratio of anteroposterior diameter to transverse (lateral) diameter is:

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs – Week 7 Discussion: Assessing the Abdomen

A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, the doctor ordered a CAT scan as a precaution. The CAT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.

Because of the high potential for misdiagnosis, determining the precise cause of abdominal pain can be time-consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to diagnose conditions in the abdomen better.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients and which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

Case 1: Abdominal Pain

A 12-year-old female complains of malaise with abdominal pain pointing to the right lower quadrant. The patient has been vomiting and feeling nauseated for several days. The abdominal pain has been insidious and now is more pronounced. Both parents are with the child and are concerned because she has not been eating and has had a fever for the past 3 evenings.

Case 2: Gastrointestinal Pain

A 50-year-old male complains of burning pain starting at the abdomen and rising to the middle of his chest. He describes the pain as a gnawing feeling that begins after meals, especially when lying down.

Case 3: Nausea and Vomiting

A 20-year-old female complains of nausea and has vomited three times over the past 48 hours. The patient also experienced a low-grade fever this morning. She states that she recently ate shellfish at a new restaurant with two friends who are suffering from similar symptoms.

To prepare:

With regard to the case study you were assigned:

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

Note: Before you submit your initial post, replace the subject line (“Week 7 Discussion”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Post a description of the health history you would need to collect from the patient in the case study to which you were assigned. Explain which physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject, and why. Identify the most likely condition, and justify your reasoning.

NURS 6512 Week 7 Quiz

Question 1

A patient suspected of having a peptic ulcer would receive further routine evaluation with all of the following except:

Question 2

Pulsus paradoxus greater than 20 mm Hg, tachycardia greater than 130 beats per minute, and increasing dyspnea are signs of:

Question 3

A 23-year-old man comes to the urgent care clinic with intense left flank and lower left quadrant pain. One patient response to history of present illness questions that further supports a tentative diagnosis of renal calculi is:

Question 4

Auscultation of borborygmi is associated with:

Question 5

When examining a patient with tense abdominal musculature, a helpful technique is to have the patient:

Question 6

Mrs. G. is 7 months pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy due to changes in the colorectal areas, such as:

Question 7

An umbilical assessment in the newborn that is of concern is:

Question 8

In order to assess for liver enlargement in the obese person, you should:

Question 9

A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. What organ is most likely injured?

Question 10

Visible intestinal peristalsis may indicate:

Question 11

Which abdominal organs also produce hormones and function as endocrine glands?

Question 12

A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:

Question 13

A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she fastens the child s diaper. Nephroblastoma is likely for this child when your physical examination of the abdomen reveals a(n):

Question 14

What condition is associated with purplish striae?

Question 15

When using the bimanual technique for palpating the abdomen, you should:

Question 16

Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?

Question 17

Ms. Green is an 85-year-old female patient with dementia who presents to the emergency department with her daughter because of a change in function. Which pain assessment scale would be the best choice?

Question 18

Body language that leads you to suspect the person is in pain is:

Question 19

Your 85-year-old patient is complaining of right knee pain. She has a history of osteoarthritis for which she is given anti-inflammatory medication. To assess her right knee pain, you should ask her if:

Question 20

The Joint Commission (TJC, formerly The Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) requires that:

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs – Week 8 Discussion: Assessing Muscoskeletal Pain

The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provide the body with support and mobility.

Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

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

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

Case 1: Back Pain

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

Note: Please view the Week 8 Discussion area to view the image for Case Study 1.

Case 2: Ankle Pain

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottowa ankle rules to determine if you need additional testing?

Note: Please view the Week 8 Discussion area to view the image for Case Study 2.

Case 3: Knee Pain

A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella.In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?

Note: Please view the Week 8 Discussion area to view the image for Case Study 3.

To prepare:

With regard to the case study you were assigned:

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

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.

NURS 6512 Week 8 Quiz

Question 1

A 7-year-old boy is brought into your office with a chief complaint of possible fracture in his left third finger. He jammed it while playing basketball 2 days ago. The mother states that she really does not think it is broken because he can move it. What is your best response?

Question 2

A patient presenting for the first time with typical low back pain should receive which of the following diagnostic tests?

Question 3

Classic carpal tunnel syndrome would result in:

Question 4

A tingling sensation radiating from the wrist to the hand on striking the median nerve is a positive _____ sign.

Question 5

A red, hot swollen joint in a 40-year-old man should lead you to suspect:

Question 6

The usual number of vertebrae is:

Question 7

In differentiating osteoarthritis from rheumatoid arthritis (RA), the osteoarthritis patient typically exhibits:

Question 8

The physical assessment technique most frequently used to assess joint symmetry is:

Question 9

During a football game, a player was struck on the lateral side of the left leg while his feet were firmly planted. He is complaining of left knee pain. To examine the left knee you should initially perform the _____ test.

Question 10

Light skin and thin body habitus are risk factors for:

Question 11

Risk factors for sports-related injuries include:

Question 12

An adult with bowed tibias and a shortened thorax may have:

Question 13

Ligaments are stronger than bone until:

Question 14

An increase in muscle tone is known as:

Question 15

A goniometer is used to assess:

Question 16

When the patient flexes forward at the waist, what spinal observation would lead you to suspect scoliosis?

Question 17

The dowager hump is:

Question 18

You note that a child has a positive Gower sign. You know that this indicates generalized:

Question 19

The elasticity of pelvic ligaments and softening of cartilage in a pregnant woman are due to:

Question 20

Injuries to long bones and joints are more likely to result in fractures than in sprains until:

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs Week 9 Discussion: Assessing Neurological Symptoms

Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.

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

Case 1: Headaches

A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.

Case 2: Numbness and Pain

A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

Case 3: Drooping of Face

A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.

To prepare:

With regard to the case study you were assigned:

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

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 9”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Read a selection of your colleagues’ responses.

By Day 6

NURS 6512 Week 9 Quiz

Question 1

A woman brings her husband to the emergency department and states that he is having a stroke. You are the student NP on the hospitalist service and are sent down first to obtain the history and physical. You develop a differential diagnosis and know that the initial gold standard radiology test to further evaluate is:

Question 2

You are examining a patient in the emergency department who has recently sustained head trauma. In order to initially assess this patient s neurologic status, you would:

Question 3

While interviewing a patient, you ask him to explain the Lion and the Mouse in order to assess:

Question 4

Which area of the brain is responsible for perceiving sounds and for determining their source?

Question 5

You are initially evaluating the equilibrium of Ms. Q. You ask her to stand with her feet together and arms at her sides. She loses her balance. Ms. Q. has a positive:

Question 6

An older adult is administered the Set Test and scores a 14. The nurse interprets this score as indicative of:

Question 7

To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested?

Question 8

The examiner should be concerned about neurologic competence if a social smile cannot be elicited by the time a child is _____ old.

Question 9

Environmental hazards and cognitive function are data needed for the personal and social history section of a neurologic assessment for:

Question 10

When you ask the patient to tell you the meaning of a proverb or metaphor, you are assessing which of the following?

Question 11

Appropriateness of logic, sequence, cohesion, and relevance to topics are markers for assessment of:

Question 12

Facial muscle or tongue weakness may result in:

Question 13

If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires further evaluation?

Question 14

The finger-to-nose test allows assessment of:

Question 15

Visible or palpable extension of the elbow is caused by reflex contraction of which muscle?

Question 16

The major portion of brain growth and myelinization occurs between ____ year(s) of age.

Question 17

At what age should the infant begin to transfer objects from hand to hand?

Question 18

An acute polyneuropathy that commonly follows a nonspecific infection occurring 10 to 14 days earlier and that primarily affects the motor and autonomic peripheral nerves in an ascending pattern is:

Question 19

The Mini-Mental State Examination:

Question 20

You have asked a patient to close his eyes and identify an object placed in his hand. You are evaluating:

ORDER NOW FOR A CUSTOMIZED ACADEMIC PAPER

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs Week 10 Discussion: Assessing the Genitalia and Rectum

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

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

Case 1: Rectal Bleeding

A 62-year-old male construction worker reports to your clinic after experiencing rectal bleeding for over 1 month. He has noticed small amounts of blood after every bowel movement. He had a colonoscopy 2 years ago with normal results. The patient has no fever, chills, dysuria, abnormal urinary frequency, or abdominal pain. The patient reports occasional rectal itching and pain. He states he has no noticeable sores on his rectal area and no family history of colorectal cancer.

Case 2: Dysuria

A 55-year-old African-American male reports to your clinic complaining of frequent and painful urination for the past 2 months. The patient is sexually active and has been in a monogamous relationship for the past 3 years. He reports no penile discharge, fever, chills, abdominal pain, or back pain. His father is deceased and passed away of colon cancer. His father had a history of benign prostatic hypertrophy (BPH). The patient considers himself as a healthy male. He works for a large American corporation, has a relatively healthy diet, and exercises 4 to 5 times per week.

Case 3: Genitalia

A 21-year-old college student reports to your clinic with external bumps on her genital area. The bumps are painless and feel rough. The patient is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. The patient reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She had one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

To prepare:

With regard to the case study you were assigned:

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

Note: Before you submit your initial post, replace the subject line (“Week 10 Discussion”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject, and why. Identify the most likely condition, and justify your reasoning.

NURS 6512 Week 10 Quiz

Question 1

Prostate examination findings of a hard, irregular, painless nodule with obliteration of the median sulcus are signs of:

Question 2

Bimanual examination of the uterus includes:

Question 3

Which of the following is a normal component of vaginal discharge seen on a wet mount?

Question 4

The tail of Spence extends:

Question 5

When should girls be taught to perform breast self-examination?

Question 6

The form of gynecologic cancer that is increased in obese women is:

Question 7

Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You should:

Question 8

A 70-year-old man has a prostate-specific antigen (PSA) value of 6 and a negative digital rectal examination (DRE). These findings indicate:

Question 9

Initial digital approach to the rectal examination should be:

Question 10

The most emergent cause of testicular pain in a young male is:

Question 11

The risk of ovarian cancer is increased by a history of:

Question 12

A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. Upon inspection, you find posterior vulvar and gross perineum bruising. These findings are consistent with:

Question 13

The mother of a newborn boy tells you that her baby s breasts are swollen and sometimes look as if they are leaking milk. It is most appropriate to tell her that the:

Question 14

Your patient s chief complaint is repeated pencil-like stools. Further examination should include:

Question 15

The female patient should ideally be in which position for the pelvic examination?

Question 16

While examining an 18-year-old man, you note that the penis and testicles are more darkly pigmented than the body skin. You should consider this finding to be:

Question 17

When examining a small child, in which position should he be placed to help push the testicles into the scrotum?

Question 18

A 23-year-old female presents with severe right lower quadrant tenderness. All of the following should be considered in the differential except:

Question 19

What is the initial diagnostic radiology test that should be ordered if you suspect a ruptured ovarian cyst?

Question 20

A 17-year-old male was brought into the emergency room with testicular/scrotal pain. The differential diagnosis should include all except:

NURS 6512 Advanced Health Assessment and Diagnostic Reasoning DQs

NURS 6512 Week 11 Discussion: Ethical Concerns

As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?

In this Discussion, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.

Scenario 1:

The parents of a 5-year-old boy have accompanied their son for his required physical examination before starting kindergarten. His parents are opposed to him receiving any vaccines.

Scenario 2:

A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance.

Scenario 3:

A 27-year-old man with Crohn’s disease has been admitted to the emergency room with an extreme flare-up of his condition. He explains that he has not been able to afford his medications for the last few months and is concerned about the costs he may incur for treatment.

Scenario 4:

A single mother has accompanied her two daughters, aged 15 and 13, to a women’s health clinic and has requested that the girls receive a pelvic examination and be put on birth control. The girls have consented to the exam but seem unsettled.

Scenario 5:

A 17-year-old boy has come in for a check-up after a head injury during a football game. He has indicated that he would like to be able to play in the next game, which is in 3 days.

Scenario 6:

A 12-year-old girl has come in for a routine check-up and has not yet received the HPV vaccine. Her family is very religious and believes that the vaccine would encourage premarital sexual activity.

Scenario 7:

A 57-year-old man who was diagnosed with motor neuron disease 2 years ago is experiencing a rapid decline in his condition. He prefers to be admitted to the in-patient unit at a hospice to receive end-of-life care, but his wife wants him to remain at home.

To prepare:

Select three scenarios, and reflect on the material presented throughout this course.
What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.

By Day 3

Post the explanation of the health assessment information required for a diagnosis of your selected patients (include the scenario numbers). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your responses.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different scenarios than you, using one or more of the following approaches:

Suggest additional health assessment information that would be necessary to collect from the patient
Critique your colleague’s response, and explain alternative approaches to the situation.
Validate an idea with your own experience and additional research.

NURS 6512 Week 11 Quiz

Question 1

When interviewing a disabled patient, it is best to speak to:

Question 2

Which of the following is most likely to enhance examiner reliability?

Question 3

Throughout the history and physical examination, the clinician should:

Question 4

At your first meeting with a patient, it is usually best to say:

Question 5

Which of the following is true regarding the relationship between the examiner and the patient?

Question 6

When conducting a geriatric assessment, basic activities of daily living (ADLs) include:

Question 7

Your 15-year-old patient is athletic and thin. Radiography of an ankle injury reveals a stress fracture. You should question this patient about her:

Question 8

The reliability of health-related findings and observations is the responsibility of the:

Question 9

The cranial nerves are usually assessed while the patient is in which position?

Question 10

The best way to ease the apprehension of a 3-year-old child before a physical examination is to:

Question 11

When you attempt to move a 10-month-old child from his mother s lap to the examination table, he screams loudly. Your best action is to:

Question 12

Palpation of epitrochlear nodes is part of the:.

Question 13

Which medical condition would exclude one from sports participation?

Question 14

The greatest risk for potential health problems occurs in which age group?

Question 15

Functional assessment is most important during the examination of a(n):

Question 16

When conveying bad or distasteful news to the patient and family, it is best to:

Question 17

The checkout station for preparticipation physical evaluation (PPE) is critical because at this point:

Question 18

To promote your examination time with a cooperative child, your approach to the examination should be to:

Question 19

Which of the following data are not part of your general inspection?

Question 20

Part of the screening orthopedic component of the examination includes evaluating the person while: