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PHIL 347N Final Exam | Complete Solution

(TCOs 1, 2) Determine whether the following passage is an argument.

Mark is the newest member of the requisitions department. The requisitions department oversees the purchasing of all goods, services, and capital equipment for the entire company. (Points : 5)

Argument

Not an argument because there are no claims or only one claim

Not an argument because none of the claims offers a reason for the other

Not an argument because the reasons explain rather than prove the other claims

Question 2.

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2. (TCOs 1, 2) Determine whether the following passage is an argument.

Either you are planning to vote in the fall election or you donât really want to improve the politics of the local community. (Points : 5) PHIL 347N Final Exam

Argument

Not an argument because there are no claims or only one claim

Not an argument because none of the claims offers a reason for the other

Not an argument because the reasons explain rather than prove the other claims

Question 3.

3. (TCOs 2, 3) Choose the best answer.

Donât drive over the speed limit. Itâs against the law. You donât want a speeding ticket.

Which of the following claims represents the conclusion of this argument? (Points : 5)

Driving over the speed limit is against the law.

You donât want a speeding ticket.

You should not drive over the speed limit.

Question 4.

4. (TCOs 2, 3) Choose the best answer.

Healthy. Delicious. Drink Ovaltine!

Which of the following claims represents the implied conclusion of this argument? (Points : 5) PHIL 347N Final Exam

Ovaltine is healthy.

Ovaltine is delicious

You should drink Ovaltine.

None; this is not an argument.

Question 5.

5. (TCOs 3, 4) Identify the kind of argument.

Since all Ford Mustangs are automobiles, and not all Ford Mustangs are red, some automobiles are not red. (Points : 5)

Causal argument

Categorical argument

Inductive generalization

Analogical argument

Question 6.

6. (TCOs 3, 4) Identify the kind of argument.

Using a lemon when cooking is like using a lime. Given that limes can be added to bland foods to give them some zest, lemons, too, will give zest to bland foods. (Points : 5)

Analogical argument

Categorical argument

Truth-functional argument

Causal argument

Question 7.

7. (TCO 3, 4) Identify the kind of argument.

Learning to think critically is like learning to play the piano. Given that you have to practice a lot to be good at playing the piano, you must practice a lot to be a critical thinker. (Points : 5)

Causal argument

Truth-functional argument

Inductive generalization

Analogical argument

Question 8.

8. (TCOs 2, 3, 5) Relate to the proper terminology.

What evaluative language should you use for analogical arguments? (Points : 5)

Valid/invalid; cogent/uncogent

Valid/invalid; sound/unsound

Strong/weak; cogent/uncogent

Strong/weak; sound/unsound

Question 9.

9. (TCOs 2, 3, 5) Relate to the proper terminology.

What evaluative language should you use for truth-functional arguments? (Points : 5)

Valid/invalid; cogent/uncogent

Valid/invalid; sound/unsound

Strong/weak; cogent/uncogent

Strong/weak; sound/unsound

Question 10.

10. (TCO 4) Select the answer that represents the proper standard form for the following statement.

The bill should be paid by whoever bought the item. (Points : 5)

All people who bought the items are not people who should pay the bill.

All people who pay the bill are people who bought the item.

All people who bought the item are people who should pay the bill.

Question 11.

11. (TCO 4) Select the answer that represents the proper standard form for the following statement.

Some sports cars are red. (Points : 5)

No red things are sports cars.

Some sports cars are red things.

All sports cars are red things.

Question 12.

12. (21. (TCO 4) Select the answer that represents the proper standard form for the following statement.

If you want to be a nursing major, then you must take an anatomy class. (Points : 5) PHIL 347N Final Exam

Valid/invalid; cogent/uncogent

Valid/invalid; sound/unsound

All people who want to be nursing majors are people who must take an anatomy class.

Strong/weak; sound/unsound

Question 13.

13. (TCO 4) Choose the correct translation for each of the following compound claims.

You cannot enter the chess tournament (C) unless you are ranked (R). (Points : 5)

R ⢠~ C

C > R

~ C > R

~ R > ~ C

Question 14.

14. (TCO 4) Choose the correct translation for each of the following compound claims.

Small-scale agriculture will be profitable (P) and growers will get subsidies (S) only if demand (D) for local food does not decrease. (Points : 5)

~ [D > (P ⢠S)]

(P ⢠S) > ~ D

~ D > (P ⢠S)

P ⢠(S > ~ D)

Question 15.

15. (TCOs 3, 5) Which inductive generalization is stronger? (Points : 5)

Our universityâs womenâs basketball team has won its last three games. Thus, it seems obvious that the team will repeat as champions this year.

Our universityâs womenâs basketball team has won its last six games. Thus, it seems obvious that the team will repeat as champions this year. PHIL 347N Final Exam

Question 16.

16. (TCOs 3, 5) Which analogical argument is stronger? (Points : 5)

Grease, oil, road tar, and paint thinner are all flammable. Thus, paint thinner is a refined product because grease, oil, and road tar are refined products.

Grease, oil, and paint thinner are all flammable. Thus, paint thinner is a refined product since grease and oil are refined products.

Question 17.

17. (TCOs 3, 5) Which causal argument is stronger? (Points : 5)

The population of frogs in three California counties has declined dramatically in the last decade. Loss of habitat must be the cause because increased demand for housing has eliminated more than half of the available wetlands in all three counties, and this appears to be the only factor all three have in common.

The population of frogs in three California counties has declined dramatically in the last decade. Loss of habitat must be the cause because increased demand for housing has eliminated more than half of the available wetlands in all three counties, and this appears to be the only factor all three have in common. Only one county is rural, and only two counties have experienced an increase in frog predators.

Question 18.

18. (TCO 6) Identify the fallacy.

The Chinese government should encourage freedom of speech because doing so would be a good idea. (Points : 5)

Begging the question

Appeal to ignorance

Strawman

No fallacy committed

Question 19.

19. (TCO 6) Identify the fallacy.

Has anyone ever proven that soccer players would be protected from head injuries if they wore some kind of helmet? Then it must be true that helmets are unnecessary in soccer. (Points : 5) PHIL 347N Final Exam

Ad hominem

Appeal to ignorance

Strawman

Begging the question

Question 20.

20. (TCO 6) Identify the fallacy.

Mr. Banks cancels meetings at the last minute for no reason at all. At the meetings he does not cancel, he has lately been showing up smelling of alcohol. Now he cannot account for the disappearance of over 700 dollars raised last year. Clearly, it is inappropriate to keep him on as scout leader. (Points : 5)

Appeal to ignorance

Red herring

No fallacy committed

Ad hominem PHIL 347N Final Exam

NAPSRx Final Exam

1. How are drugs sorted into therapeutic groups and classes?

A. first by the conditions that they are used to treat. and then by their mechanisms of action

B. first by their mechanisms of action. and then by their therapeutic effects

C. first by their side effects. and then by their therapeutic effects

D. first by their toxicity. and then by their effectiveness

2. Bone marrow transplants…

A. require that the patient first undergo chemotherapy or radiation to kill the diseased stem cells and promote white blood cell production. NAPSRx Final Exam

B. are a type of stem cell therapy. unless patient’s own cells are reinjected.

C. are always a type of stem cell therapy.

D. can help people with leukemia. a condition in which the body does not produce enough white blood cells.

3. What does AMA stand for?

A. American Medical Academy

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B. American Medical Accreditation

C. American Medical Association

D. Association of Medical Assistants

4. What section of a drug’s package insert describes situations in which the drug should not be used because the risks outweigh the therapeutic benefits?

A. adverse reactions

B. contraindications

C. overdosage

D. warning/precautions

5 What is tertiary care?

A. adding medications together to achieve a better clinical effect

B.highly specialized medical and surgical care provided by a large medical center for unusual or complex medical problems

C. receiving medical or surgical care that does not require an overnight stay in the treatment facility

D. seeing a physician for routine checkups and general healthcare

6. Which of the following is NOT one of the stages in the classic approach to brand development strategy covered in your manual? NAPSRx Final Exam

A. brand personality

B. brand positoning

C.brand quality

D. brand values

7 What are vasodilators used to do?

A. decrease vascular resistance and increase blood flow

B. mimic pathogens to stimulate the immune system

C. narrow the blood vessels

D.stimulate the CNS to make the heart beat faster

8. What is the name of the condition that occurs after a specific dose of a drug is given at such regular intervals that absorption and elimination (and therefore drug plasma concentration) have become fairly constant?

A. homeostasis

B.steady state

C. titration

D. tolerance

9. Which statement is TRUE about ocular administration?

A. Ocular administration is primarily for drugs that must cross the blood-brain barrier.

B. Ocular administration is used primarily to treat the eye. NAPSRx Final Exam

C. Ocular administration is used when a drug must enter the bloodstream immediately.

D. Ocular administration is used when a drug must produce immediate effects on the brain or spinal cord.

10. Which entities invest’s the most money in pharmaceutical R&D?

A. Canadian pharmaceutical companies

B. the NIH

C. the U.S. Government

D.U.S. pharmaceutical companies

11. How are most drugs excreted?

A. via the bloodstream

B. via the heart

C. via the kidneys

D. via the skin

12. Over the last few decades, what has happened to legal limitations on sales’ reps discussions about off label uses?

A. Limitations have decreased.

B. Limitations have increased significantly.

C. Limitations have increased slightly.

D. Limitations have remained about the same.

 

13. Answer: Branding name

 

14. What does it mean if two drugs are at parity?

A. Both drugs are essentially in a neutral position.

B. Both drugs are generics.

C. Both drugs have exclusive preferred status.

D. The two drugs are bioequivalent.

15 Who is most likely to benefit from electronic sampling programs?

A. Everyone would benefit equally from electronic sampling programs

B. physicians in hospitals who are too busy to see representatives

C. physicians in rural areas who are not as frequently visited by representatives

D. physicians in urban areas who are too busy to see representatives

16. When referring to medication dosage, which abbreviation means “one-half’:

A.MS

B.OH

C. SM

D. SS

17 What is an internist?

A. a physician who practices internal medicine

B. a physician’s intern

C. a type of oncologist who specializes in chemotherapy

D. an internal sales representative

18. Which of the following is a type of white blood cell?

A. erythrocytes

B. insulin

C. Lymphocytes

D.HCs

19. Why are novice sales representatives often placed in charge of negotiating MCO formularies?

A. to become more familiar with the healthcare industry

B. to become more familiar with their territories

C. P&T committees are more receptive to new faces.

D. They are not. This job is usually reserved for more experienced reps.

20. What distinguishes pharmacodynamics from pharmacokinetics?

A. Pharmacodynamics studies a drug’s ex vivo effects.

B. Pharmacodynamics studies how drugs affect the body.

C. Pharmacodynamics studies the how the body affects drugs.

D. Pharmacodynamics studies the time required for a drug’s absorption.

21 What proportion of the drugs tested on human subjects are eventually approved by the FDA?

A. about 20%

B. about 60%

C. about 70%

D. about 95%

22. According to a study discussed in your manual, how do most physicians prefer to receive their drug samples?

A. by borrowing them from hospitals

B. by ordering them over the Internet

C. by trading them for services

D.directly from sales representatives

23. Which of the following is an example of a central value?

A. I buy Advil to show that I’m a modern consumer.

B. I like Advil because we were both born in the 80s.

C. I prefer Advil because I like the flavor.

D. I prefer Advil because it’s easier to swallow.

24. Which of the following specialties likely has the MOST emergency calls?

A. cardiology

B. psychiatry

C. urology

D. All specialists have the same number of emergency calls.

25. What affects the rate of active transport?

A. the availability of carriers. but not energy

B. the availability of energy. but not carriers

C. the availability of carriers and energy

D. neither the availability of carriers nor the availability of energy

26. Over the last few decades, what has happened to the FDA approval time for new drugs?

A. It has been lengthened to ensure safer drug products.

B. It has been lengthened to limit DTC marketing

C. It has been shortened to improve drug quality

D. It has been shortened to reduce the cost of new drug development.

27. Which of the following would NOT help improve compliance?

A. patients liking their providers

B. patients using only one pharmacist

C. pharmacists understanding how generics differ from brand name drugs

D.  support groups

28. Which entity chooses a drug’s trade name?

A. the drug’s inventor

B. the drug’s manufacturer

C.the FDA

D. the United States Pharmaceutical Council

29. What type of stem cells are obtained from embryos and can develop into any cell type?

A. multipotent

B.  pluripotent

C. totipotent

D. All stem cells can develop into any cell type.

30. As the price a patient pays for a prescription increases, what happens to the likelihood that the patient will fill it?

A. It decreases.

B. It increases.

C. It remains unaffected because the prescription is needed.

D. It remains unaffected because the prescription’s increased cost is offset by its perceived value.

31. Most involuntary movements come from which type of muscle tissue?

A. cardiac and smooth

B. only skeletal

C. skeletal and cardiac

D. skeletal and smooth

32. Which of the following is NOT one of the body’s major organ systems?

A. the cardiovascular system

B. the cellular system

C. the gastrointestinal system

D.  the musculoskeletal system

33. How do most drugs exert their primary physiological effects?

A.  by activating synapses between different types of tissues

B. by binding to cell receptors that are sensitive to their presence

C. by inhibiting synapses between different types of tissues

D.  through genetic mutation

34. What is the most reliable source of information for determining therapeutically equivalent drug products?

A. AMA guide

B. Blue Book

C. FDA drug list

D.  Orange Book

35. What does subcutaneous mean?

A. beneath the intervention

B. beneath the muscle tissue

C. beneath the outer skin

D. beneath the suture

36. What should a sales representative do if all of the prime spaces in a drug cabinet are coccupied?

A. ask staff for permission to move some of the other products in the cabinet

B. ask staff for permission to throw away expired products in the cabinet

C. ask the doctor if he still needs some of the other products in the cabinet

D. surreptitiously move your largest competitors’ products out of the way

37. It is inappropriate for physicians’ prescribing behaviors to be educated by their personal tastes and idiosyncrasies

A. TRUE

B. FALSE

38.The FDA defines API as the active__ ingredient in a drug, which produces the desired change in the body.

A. pharmaceutical

B. positive

C. potent

D.  primary

39. What are the 2 legal classifications of wholesalers?

A. distributors and supply chains

B. pharmacists and NAMs

C. primary and secondary wholesale distributors

D. retailers and institutions

40.What term describes the usage of a medication for purposes other than the FDA-approved indications on the labeling?

A. contraindicative indication

B. off-indication usage

C or D. off-label

 

41. What is the acronym for pharmacokinetics?

A. KN

B. PC

C. PK

D. pT

42. The dosage range of a drug that is both safe and beneficial is known as the therapeutic window.

A. TRUE

B. FALSE

43. What is typically NOT a characteristic of a pharmaceutical sales rep?

A. Pharmaceutical sales reps are authentic and real.

B. Pharmaceutical sales reps are creative.

C. Pharmaceutical sales reps are focused.

D. Pharmaceutical sales reps are not concerned about competitors.

44. What entity grants drug patents?

A. the FDA

B. the FDA if the drug is over-the-counter and the U.S. Patent and Trademark Office if the drug is prescription

C. the FDA if the drug is prescription and the U.S. Patent and Trademark Office if the drug is over-the-counter

D. the U.S. Patent and Trademark Office

45. Which of the following refers to all active and inert pharmaceutical ingredients in a drug, including fillers and colors?

A. formulation

B. mycoplasma

C. peptide

D. saccharide

46. What is the difference between potency and efficacy?

A. Doctors prefer more potent drugs.

B. Drug manufacturers prefer more potent drugs.

C. Potency refers to the drug’s effectiveness. while efficacy refers to its strength.

D. Potency refers to the drug’s strength, while efficacy refers to its effectiveness.

47. What is the minimum level of education required for a nurse practitioner?

A. a certification program

B. an associate’s degree

C. a bachelor’s degree

D. a graduate degree

48. How many names must a drug have?

A. at most three

B. at least three

C. at most five

D. at least five

49. How has a longer development time increased the cost of bringing a new drug to market?

Answer: Increasing the cost of capital

Explaination (Option Not taken so find out in below para): Lengthening development time dramatically increase the cost of bringing a new drug to market by increasing the cost of capital needed for R&D. The cost of capital increases as companies are exposed to Economic Risk and uncertainty over a longer period of development time. Stringent FDA guideline and long approval times have greatly increased the cost of developing new drugs.

 

50. Senior citizens consume over times as many pharmaceuticals as people under 65.

A. three

B. five

C. ten

D. fifteen

51. What agency regulates the distribution and use of narcotics?

A. DEA

B. FTC

C. OIG

D.TSA

52. What is passive diffusion?

A. a type of pinocytosis

B. membrane transport via vesicles

C. the use of energy to help a substance pass from a low concentration gradient to a high one

D. when a substance freely moves through a membrane from a high concentration gradient to a low one

53. What are the MAIN categories of drugs under FDA jurisdiction?

A. active drugs and active placebos

B. biopharmaceuticals and nutraceuticals

C. non-prescription and nutraceuticals

D. prescription and non prescription

 

54. Answer: Oxytocin

 

55. What are all metabolites?

A. active substances

B. inactive substances

C. injections

D. products of metabolism

56. When a drug is administered orally, where does first-pass metabolism occur?

A. intestine

B. liver

C. pancreas

D. stomach

57. What is the medical term for swelling?

A. assay

B. edema

C. instillation

D. protease

58. Which of the following is NOT part of the Seven Step Cascade of Emotion?

A. be a consultant. not a rep

B. identify what your product does

C. reflect

D. visualize the power of 10

59. Which part of a clinical research paper is frequently referred to as the road map?

A. abstract

B. findings

C. letter to the editor

D .methods

60. Which of the following is a main active ingredient in lung surfactants?

A. animal lung extract

B.  germicides

C.  sympathomimetic drugs

D.  theophylline

61. What does parenteral mean?

A. child prescriptions

B. injection

C. oral

D. tablet

62. Which term denotes a type of substance that enhances the action of a drug or antigen?

A. adjuvant

B. indicated

C. ligase

D peptide

63. If a sales representative’s product is placed on the second tier of a standard three-tier formulary, which of the following is most likely true?

A. It has not been reviewed by the P&T committee.

B. It is in a neutral position unless it is at parity with other drugs.

C. It probably has exclusive preferred status if it is not at parity with any other drugs.

D. It will essentially sell itself if it is granted exclusive preferred status.

64. Which of the following is NOT one of the four basic transport mechanisms?

A. active transport

B. homeostasis

C. passive diffusion

D. pinocytosis

65. Which statement accurately describes a relationship between drug agonists and antagonists?

A. Agonists and antagonists can be used together.

B. Agonists and antagonists should not be used together.

C. Antagonist drugs activate receptors. while agonists block access to receptors.

D. Antagonists are endogenous whereas agonists are man-made.

66. What is the study of the effects and movement of drugs in the human body?

A. anatomy

B. antology

C. clinical pharmacology

D. pathology

67. According to your manual, what is a common complaint that physicians have about traditional sampling methods?

A. that drug sample supply is too unpredictable

B. that patients are less likely to take free samples because they think they are lower quality

C. that patients do not like seeing drug representatives in their offices

D. that they receive too many drug samples

68. Which of these entities is formed by two or more hospitals or other healthcare entities to negotiate reduced rates with its aggregated purchasing power?

A. GPO

B. In-state wholesaler

C. PPO

D. RPO

69. What is another name for a drug derived from a biologic compound?

A. large molecule

B. oligonucleotide

C. orgaanism

D. small molecule

70. What is the most common policy regarding pharmaceutical reps dispensing drug samples in hospitals?

A. By federal law. drug sampling is permitted in all hospitals.

B. By federal law. it is up to individual physicians. not the hospital.

C. Drug sampling is encouraged. but not required.

D. Drug sampling is often forbidden.

71 Which of the following would help you build trust with a physician?

A. asking if he or she is having any problems with the managed care coverage of your products

B. repeating a question you already asked

C. surprising the office staff with a new poster in the break room

D. None of these would help you build trust with a physician.

72. What term denotes the difference between the usual effective dose and the dose that induces severe or life-threatening side effects?

A. dose-response relationship

B. margin of safety

C. the placebo effect

D. therapeutic window

73. What are excipients?

A. a type of cell receptor to which antagonists bind to decrease the effects of the body’s natural agonists

B. another term for generic equivalents

C. sites of action besides the target sites of action

D.the inert ingredients in a drug formulation

74. What is another term for the AWP?

A. dock-to-dock price

B. float price

C. list price

D. non-stock price

75. Which of these is the most likely use for auterotonic agent?

A. to induce labor

B. to make the urine more alkaline

C. to supplement oral food intake

D. to treat hyperthyroidism

76. As of November 2013, which of these countries has legalized DTC advertising of prescription drugs?

A. Canada

B. Japan

C. Spain

D. none of these

77. Why are oral drugs often taken on an empty stomach?

A.  to be more wholly absorbed by the stomach

B. to minimize absorption by the intestine

C.  to minimize nausea

D.to pass through the stomach more quickly

78. What is one factor that differentiates community health centers from hospitals?

A.  Community health center formularies are more restrictive.

B. Community health centers have higher reimbursement rates.

C. Newer brand name drugs are easier to access at community health centers.

D. None of these

79. How does drug sampling provide a social benefit?

A. Doctors donate their unused drug samples to charities.

B. Doctors often use drug samples to treat patients who otherwise could not afford it.

C. It allows patients to try out different prescription medications before consulting with physicians.

D.  Drug sampling provides a social benefit in all of these ways.

80. Which medical term denotes the use of a stethoscope to listen to the heart?

A. auscultation

B. cardioversion

C. catheterization

D. echocardiography

81. What do enteric coatings do?

A. facilitate vomiting

B. help drugs dissolve in the stomach

C. help drugs enter the bloodstream more quickly

D. prevent dissolution in the stomach

82. What is the duration of exclusivity for orphan drugs?

A.  6 months

B. 1 year

C.  7 years

D.  15 years

83. What do National Account Managers do?

A. act as the sales reps’ primary point of contact with the rest of the corporation

B. manage the FDA approval process

C. negotiate contracts with MCOs and PBMs

D.  sell only to pharmacies

84. What does it usually mean if a drug recall is voluntary?

A. Pharmacies may choose whether to return the drug or dispense it.

B. The FDA has determined that the drug is perfectly safe. but ineffective.

C. The manufacturer has recalled the product on its own. but negotiated with the FDA beforehand.

D. The manufacturer has recalled the product without negotiating with the FDA.

85. Which phase of clinical trials is also known as the pivotal phase?

A. Phase I

B. Phase III

C Phase IV

D. Phase IX

86. During which phase of clinical trials is the new drug’s safety and effectiveness first tested in the target group?

A. preclinical NAPSRx Final Exam

B. Phase I

C. Phase II

D. Phase III

87. How do antacids work?

A. by increasing blood flow to the stomach

B. by lowering gastric pH

C. by raising gastric pH

D. by suppressing cholesterol formation by the liver

88. What is one of the biggest time wasters for a pharmaceutical sales rep?

A. Caterers

B. Pharcists

C. receptionists

D. travel time

89. What happens when equilibrium is reached?

A.  equal numbers of molecules cross the membrane in both directions

B.  molecules stop moving

C. the concentration gradient decreases indefinitely

D. the concentration gradient increases indefinitely

90. What are the most common vectors used in gene therapy?

A.  autologous antigens

B. liposomes

C. naked DNA

D. viruses

91. What is the percentage fee that the dispenser pays the wholesaler for distribution?

A. margin fee

B. recharge

C. standard fee

D. upcharge

92. What is the difference between a chronic (or continuing) reaction, and a delayed reaction?

A. Chronic reactions are exaggerated. whereas delayed reactions are idiosyncratic.

B. Chronic reactions occur only during treatment. whereas delayed reactions only occur during withdrawal.

C. Chronic reactions persist for a long time. whereas delayed reactions take some time to develop.

D. Delayed reactions are always idiosyncratic. but chronic reactions are not. NAPSRx Final Exam

93 What is clinical effect?

A. federally funded research condition

B. the effect of maximum dosage

C. the response produced by a medication

D. the use of treatment drugs in chemotherapy

94. Which of the following is an example of noncompliance?

A. a patient forgetting to take a drug at a specified time of day

B. a patient taking a drug. but only because it has been court-mandated

C. a pharmacist dispensing a generic equivalent of a drug instead of the brand name

D. a physician refusing to prescribe a drug because he or she does not trust the clinical studies on it

95. What is the average circulation time of blood?

A. about a minute

B. about 5 minutes

C. about 5 to 10 minutes depending on the patient’s age and health conditions

D. about 10 minutes

96. What is one way in which pharmaceutical selling is different from selling in most other industries?

A. In pharmaceutical sales. the decisions-makers. consumers. and payers are usually the same entity.

B. Pharmaceutical selling takes less time because doctors are so busy.

C. Representatives do NOT sell to the end user of the product. NAPSRx Final Exam

D. Representatives DO sell to the end user of the product.

97. From what types of entities do primary wholesale distributors buy most of their drugs?

A. brokerages

B. buying clubs

C. manufacturers

D. physicians

98.What is the Office of the Inspector General (01G)?

A. a department in pharmaceutical companies

B. an arm of the Department of Health and Human Services

C. an arm of the European Medicines Agency D an arm of the FDA

99. What are doctors required to consider when deciding whether or not to prescribe a particular drug?

A. quantity of life over quality of life

B. that no drugs with adverse effects should ever be used

C. the inferiority of OTC drugs

D. the severity of the disorder being treated and the effect it has on the patient’s quality of life

100. Which entity assigns a new drug its generic names?

A. the drug’s inventor

B. the Food and Drug Administration

C. the United States Adopted Name Council

D. the United States Pharmaceutical Council

101. Drugs can be used days beyond their expiration date.

A.  2-7 days. depending on the most current monograph.

B.  2-90 days. depending on state laws

C. 7-90 days. depending on the type of drug and its therapeutic class.

D. none of these

102. What is necessary for a drug to be excreted extensively via the kidneys?

A. The drug must be water-soluble. and not bind too tightly to proteins in the bloodstream.

B. The drug must have a phospholipid bilayer and be non-water-soluble.

C. The drug must have a phospholipid bilayer and bind well to proteins in the bloodstream.

D. The drug must not be water-soluble.

103. Which organization or individual initiates the clinical trial and finances the study?

A. clinical research organization

B. investigator

C. researcher

D. sponsor

104. The name describes the atomic or molecular structure of a drug.

A. chemical

B.  generic

C. pharmaceutical

D. proprietary

105. Under PhRMA Code, is it acceptable or unacceptable for a pharmaceutical sales rep to take a physician and the physician’s spouse to a fundraising dinner?

A. acceptable if only the physician attends

B. acceptable if only the physician attends. and the total is under $100

C. acceptable if the total is under $100

D. unacceptable

106. The Hatch-Waxman Act is considered the most significant drug-related affecting the pharmaceutical industry since 1962. NAPSRx Final Exam

A. experiment

B. legislation

C. process

D. research

107. What term denotes the the extent, quality, or degree to which a substance is poisonous or harmful to the body?

A. caliber

B. chronicity

C. indication

D. toxicity

108. What issue has MOST encouraged consumers’ desire to see more OTC medications?

A. a weaker patients’ rights movement

B.lack of insurance coverage

C. less reliance on the Internet

D. proliferation of herbal remedies

109. What is the degree to which a medication produces a therapeutic effect?

A. diffusion

B. efficacy

C. protease

D. vector

110. What is the most important benefit of electronic prescribing?

A. Choice

B. cost

C. inquiries

D.  safety

111. When does the FDA regulate generic drugs?

A. only if they are branded generics

B. only if they have been contested

C. always

D never

112. Which phase of trials largely determines the clinical dose?

A. preclinical trials

B. Phase II trials

C. Phase III trials

D. Phase IV trials

113. What is an advantage of inactivated vaccines over attenuated vaccines?

A.  Inactivated vaccines are less expensive to prepare.

B. Inactivated vaccines have a higher probability of eliciting the desired immunological response.

C. Inactivated vaccines have a more stable shelf life. NAPSRx Final Exam

D.  Inactivated vaccines only require a single dose.

114. Which medical term denotes a low supply of oxygen due to low blood flow?

A. potentiation

B. ischemia

C. TID

D. titration

115. What are the two main types of prescription drug marketing?

A. (1) marketing to insurance companies. and (2) marketing to pharmacies

B. (1) PBM marketing. and (2) marketing to governments

C. (1) professional physician promotions. and (2) direct-to-consumer advertising

D. (1) publicly-funded marketing. and (2) physician-funded marketing

116. What is the site of delivery for subcutaneous injections?

A. fatty tissuebeneath the surface of the skin

B.  lymphatic tissue

C. muscle tissue

D. the stomach, via a special type of needle

117. What must be contained in the Description section of a pharmaceutical package insert?

A. adverse effects

B. mechanism of action

C. pharmacokinetics

D. the proprietary name and the established name

118. What is the study of a medication’s effects as it travels through the body?

A. pharmacodynamics

B. pharmacogenetics

C. pharmacogenomics

D. pharmacokinetics

119. Customers purchase products from people they like, trust, and respect. This is called the

A. closing of the sale

B. first time advantage

C. likeability factor

D. power of knowledge

120. What is penicillin’s primary mechanism of action?

A. It disturbs bacterial cell wall synthesis.

B It inhibits the production of viruses.

C. It prevents proper DNA replication.

D. It sends a messenger to the bone marrow to produce extra white blood cells

121. According to your manual, how has the U.S. healthcare marketplace changed in the last few decades?

A. Fewer and fewer prescription drugs have been made available as OTCs.

B. Managed care has been increasingly replaced by more patient-centered approaches.

C. The aging Baby Boomer generation has begun demanding more personalized attention.

D. There has been decreased emphasis on preventive health.

122. How does pharmaceutical marketing help narrow the treatment gap?

A. It encourages patients to take more active roles in their healthcare. NAPSRx Final Exam

B. It makes doctors more skeptical of the pharmaceutical industry.

C. It makes patients more skeptical of their doctors’ opinions.

D. all of these

123. What do immunosuppressive agents do?

A. decrease risk of infection

B. increase risk of infection

C. reduce the risk of rejection of foreign bodies

D. treat psoriasis

124. What types of drugs are EGFR inhibitors?

A. antineoplastics

B. cardiovascular agents

C. CNS agents

D. mitotic inhibitors

125. Which of the following means outside of the living body?

A. en vivo

B. ex vitro

C. ex vivo

D. intra vivo

126. The FDA requirements for nutraceuticals and medicinal herbs are just as stringent as for pharmaceuticals.

A. TRUE

B. FALSE

127. What is the estimated net gain of private-sector healthcare’s contributions to increased U.S. life expectancy?

A. $5-10 billion

B. $40-50 billion

C. $800-900 billion

D.$ 2-5 trillion

128. Which statement is TRUE regarding post-approval drug monitoring?

A. All side effects are determined during clinical trials.

B. Drug manufacturers are only required to report adverse effects if they are severe or life-threatening.

C. Drug manufacturers are only required to report adverse effects if they have been proven in clinical studies.

D. The FDA can choose to withdraw their approval if new evidence arises.

129. Which term denotes when tolerance to one medication causes increased tolerance to another medication? NAPSRx Final Exam

A. cell tolerance

B. cross-tolerance

C. indicated tolerance

D. minimized tolerance

130. Patents expire __ years from the date of filing.

A. ten

B.  fifteen

C. twenty

D. thirty

131. After a trade-name drug’s patent expires, how may generic versions of it be sold?

A. only under the branded generic name

B. only under the generic name

C. only under the original trade name

D. under the original trade name or a generic name

132. What is required for a new pharmaceutical to be considered a viable therapy?

A. It causes no serious adverse effects.

B. It causes no side effects.

C. It has an active placebo.

D. It is more effective and/or causes fewer serious adverse effects than other drugs on the market.

133. Under the AMA guidelines, who is ultimately responsible for minimizing conflicts of interest?

A.  doctors

B. lawyers and office managers

C. pharmaceutical companies

D. sales representatives

134. The act of dispensing a pharmaceutical alternative for the product prescribed is

A. alternative licensure

B. equivalence practice

C.  necessitated substitution

D. pharmaceutical substitution

135. What does it mean if a drug is said to have a wide margin of safety?

A. Its safety levels have yet to be adequately verified.

B. Its safety varies widely among different types of patients.

C. There is a greater chance of severe or life-threatening side effects.

D. There is a lower chance of severe or life-threatening side effects.

136. Which of the following is the correct medical acronym for effective dose?

A. DE

B. ED

C. EFD

D. eff D

137. Why is one group of subjects given an active drug, while another group only receives a placebo? NAPSRx Final Exam

A. to assess patients’ expectations

B. to assess the drug’s effectiveness

C. to assess the professionalism of the study staff

D. to assess the subjects’ demographics

138. A generic version is likely to have some inactive ingredients that are different from those of the original drug.

A. TRUE

B. FALSE

139. Which of the following is an example of a functional value?

A.  I drink Coca-Cola because I am a citizen of the world.

B.  I drink Coca-Cola because I like looking like a traditionalist.

C.  I drink Coca-Cola because I like the taste.

D.  I drink Coca-Cola because it is an international brand.

140. Where are most drugs metabolized?

A.  interstitial spaces

B.  liver

C. stomach

D .the bloodstream

141. What is essential to the ethical requirement that subjects be selected fairly?

A. Selection criteria should be well-supported by documented evidence.

B. Studies should make every attempt to conduct research on subjects who are underprivileged and in need of medical attention.

C. Subjects should be selected based on scientific objectives.

D. all of these

142. Which of the following is the most appropriate salutation for a cover letter if you cannot find a contact name?

A. Dear Personnel Department. NAPSRx Final Exam

B. Dear Sir or Madam,

C. Dear Sir

D.To Whom It May Concern.

143. What is part of becoming an indispensable pharmaceutical sales rep?

A. asking for feedback

B. giving the doctors anything they ask for to prescribe your products

C. keeping your market share goals the same each term

D. not bothering busy doctors in hospitals

144. Which of the following is NOT typically included in the indications and usage section of the package insert information?

A. diseases or conditions that the drug is approved to treat

B. the drug’s active metabolites

C. the drug’s recommended usual dosage

D. the drug’s usual dosage range

145. Which term denotes the practice of classifying physicians and other potential prescribers by anticipated prescription volume?

A. conditioning

B. deciling

C. detailing

D. private labeling

146. What makes a drug eligible for fast track approval from the FDA?

A. It is a generic that has already been approved as a branded drug.

B. It is a new drug.

C. It is less expensive than what is currently on the market.

D. It treats patients with a serious. life-threatening condition.

147. In the gastrointestinal tract, help break up tablets to ensure full release of the active pharmaceutical ingredient.

A. binders

B. disintegrants

C. dispersing agents

D. lubricants

148. According to your manual, what does the PDRP do?

A. It educates patients on their treatment options.

B. It expands sales representatives’ access to patient information.

C. It improves communication between sales representatives and patients in doctors’ offices.

D. It limits sales representatives’ abilities to see individual physicians’ prescribing data.

149. What are the components of the central nervous system?

A. the brain and sense organs

B. the brain and spinal cord

C. the brain. spinal cord. and peripheral nervous system

D. the spinal cord and sense organs

150. Which term denotes the origin or cause of a medical condition?

A. cytology

B.  discovery

C.  etiology

D. pathology

151. Patients diagnosed with Type 1 diabetes…

A.  …do not produce enough insulin because they do not have enough B cells.

B.  …have an autoimmune disease.

C.  …produce enough insulin. but it is not as effective.

D.  …rely on insulin from porcine sources.

152. Which DTC pharmaceutical marketing tactic is permitted in European countries?NAPSRx Final Exam

A. disease state ads

B. branded billboards and disease state ads

C. branded highway billboards

D. branded radio ads

153. What is one way in which psychologists DIFFER from psychiatrists?

A. Psychologists are more concerned with subconscious memories than conscious ones.

B. Psychologists deal more with emotional than physical issues.

C. Psychologists deal more with physical issues than emotional ones.

D. Psychologists do not have graduate degrees.

154. What are PBMs?

A. governmental organizations that provide healthcare

B. organizations that design marketing campaigns

C. organizations that negotiate between pharmaceutical companies and large drug purchasers

D. organizations that write FDA new drug applications

155. How does the Hatch-Waxman Act protect research-based drug manufacturers?

A. by limiting the competition

B. by making it easier to bring generic drugs to market

C. by providing a 30-month cooling off period

D. by requiring the FDA to only look at bioavailability studies when approving an ANDA

156. What is the process of adjusting drug doses to achieve the maximum positive therapeutic effects while minimizing adverse or side effects?

A. homeostatic maximization

B. steady stateadministration

C.Sustained release

D. Titration

157. Which of the following is studied more in pharmacodynamics than in pharmacokinetics?

A. absorption. Distribution metabolism and excretion

B. dose-response effects

C. the transportation of the drug to the specific site for drug-receptor interaction

D. the way the human body deals with a drug after it has been administered

158. How does the healthy human immune system use MHC markers?

A. Substances with MHC markers are discerned as foreign and targeted for destruction.

B. Substances with MHC markers as discerned as foreign and quarantined in the liver.

C. Substances with MHC markers as discerned as foreign and quarantined in the pancreas.

D. Substances without MHC markers are discerned as foreign and targeted for destruction.

159. What is a behind-the-counter drug? NAPSRx Final Exam

A. an OTC drug that must be closely monitored by the pharmacist

B. another term for a generic prescription drug

C. another term for a prescription drug

D. another term for an OTC drug

160. When do MSLs meet with clinicians?

A. at nearly any stage of the product’s life cycle

B. only after the district’s sales representatives

C. only prior to launch

D. MSLs do not meet with physicians. NAPSRx Final Exam

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

In a 750-1000 word essay in APA format,  critically evaluate the following scenario:

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD. Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

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Subjective Data

Is very anxious and asks whether she is going to die.

Denies pain but says she feels like she cannot get enough air.

Says her heart feels like it is “running away.”

Reports that she is exhausted and cannot eat or drink by herself.

Height 175 cm; Weight 95.5kg.

Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.

Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.

Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%. Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

IV furosemide (Lasix)

Enalapril (Vasotec)

Metoprolol (Lopressor)

IV morphine sulphate (Morphine)

Inhaled short-acting bronchodilator (ProAir HFA)

Inhaled corticosteroid (Flovent HFA)

Oxygen delivered at 2L/ NC

Describe the clinical manifestations present in Mrs. J.

Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.

Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend. Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.

Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.

Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

MN502-4: Develop a philosophy that supports advanced nursing practice reflecting the values, beliefs, and cultural competencies relative to nursing practice, science, and theory

MN502-4: Develop a philosophy that supports advanced nursing practice reflecting the values, beliefs, and cultural competencies relative to nursing practice, science, and theory.

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Now that you have spent the last 8 weeks discussing theory development and exploring models and philosophies that guide advance practice nursing, it is time for you to put it all together. In this Assignment, you will create a presentation using any form of presentation software (e.g., PowerPoint®, Prezi™, Movenote™, Powtoons™, Slidedog™, and so on). Your presentation should bring together the theory that best fits your concept of advance practice nursing, the model that you will use to translate this into practice, and your final philosophy of advance practice nursing related to your role after graduation.

Please remember that your presentation should contain slides that have bullet points. The bullets should number no more than four to six per slide. The bullet point is not written as a complete sentence. It contains key words. You, as the presenter will explain in depth what each bullet point means in the audio portion of the presentation. Slides may contain graphics, but should be uncluttered. Background and font colors should be of sufficient contrast to make reading them easy on the eyes. Attention to colors should be paid so that a person who is colorblind can easily read the presentation. MN502-4: Develop a philosophy that supports advanced nursing practice reflecting the values, beliefs, and cultural competencies relative to nursing practice, science, and theory.

Assignment Details

The presentation should consist of a series of slides that include:

Title Slide: A title slide that identifies the title of the presentation and name of the student.

Introduction Slide: An introduction slide that includes brief information about you and your program track. The slide should also explain to the audience the purpose of the presentation.

Model Slides: The third and fourth slides will address your chosen model. The bullet points should consist of the specific characteristics of the model. You will need at least one citation that identifies where the model came from. Your audio will expound upon the model and what the characteristics mean. The fourth slide should include why you chose the model and how you will apply it in practice. MN502-4: Develop a philosophy that supports advanced nursing practice reflecting the values, beliefs, and cultural competencies relative to nursing practice, science, and theory

Theory Slides: The next three slides will focus on your chosen theory. The first slide should present your theory and why you chose it. The next slide would present the key concepts of the theory and how it has been used to date in past research no older than 5 years ago. The third slide will discuss how you will use this theory in practice as an advance practice nurse upon graduation.

Philosophy Slide: The next area will consist of one slide that presents your philosophy of advance practice nursing in the post-graduate role you will assume. The philosophy statement will consist of one to three sentences that distill the essence of what you believe advance practice nursing is and your conception of nursing as a profession. It is written in the first person and present tense. It is a personal statement of your beliefs about the profession of nursing. This should present guiding statements for your future practice in the advanced practice role. An example of a philosophy statement might read this way:Advanced practice nursing takes the art and science of nursing to a level of “other” and “self” interacting together to reach a state of optimal wellness guided with compassion and love for the culture of the “other.”

Graphical Slide: The next-to-last slide will be a graphical representation of how the model, theory, and your philosophy fit together.

Conclusion Slide: The last slide will be a conclusion that brings together everything you have presented. It isnota summary that just reiterates what you presented. It is a judgment about what you presented and bring the audience home, ending the presentation on a positive note about the future.

You will need supporting citations for your theory and model slides, and possibly for your philosophy, as appropriate. You will include the citations where appropriate and your very last slide will be a reference slide.

The total slide count should not exceed 15 slides. This does not include the reference slide(s) or the title slide.

Organization, documentation, references formatting guidelines must follow APA 6th edition:To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Home. MN502-4: Develop a philosophy that supports advanced nursing practice reflecting the values, beliefs, and cultural competencies relative to nursing practice, science, and theory

Total points: 300

Assignment Requirements

Before finalizing your work, you should:

be sure toread the Assignment description carefully(as displayed above);

consult the Grading Rubric(under the Course Home) to make sure you have included everything necessary; and

utilizespellingandgrammar checkto minimize errors.

Your writing Assignment should:

follow the conventions ofStandard American English(correct grammar, punctuation, etc.);

bewell ordered,logical,andunified, as well asoriginal and insightful;

displaysuperior content, organization, style,andmechanics; and

useAPA 6th Editionformat. MN502-4: Develop a philosophy that supports advanced nursing practice reflecting the values, beliefs, and cultural competencies relative to nursing practice, science, and theory

Assessing the Genitalia and Rectum Essay – Nursing 6512 – Week 10 Assignment

Introduction

Nurse practitioners will be faced with a wide range of cases that require a reserve of learning and mastery. Evaluating the genitalia and influencing a clinical conclusion when a patient presents with ambiguous subjective data can be difficult. Practitioners must be stellar with correspondence and evaluation aptitudes that will give the objective information needed to determine the appropriate diagnosis. This paper will dismember the subjective and the objective information introduced and recommend extra data that should be incorporated into this area of the SOAP note, as proved by references of current insightful literature. Assessing the Genitalia and Rectum Essay – Nursing 6512 – Week 10 Assignment. Also, current proof from literature will be displayed, analytic tests that would be imperative to assess, as well as subjective information from the patient will be recorded with references to either bolster or disprove this evaluation. As medical professionals, analytic tests must be upheld with clinical support about why it is relevant to the right diagnosis. At last, I will distinguish three conceivable conclusions to consider and put forth my defense for accepting or dismissing every finding, including the present diagnosis of choice.

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Analysis of Subjective Data

In this segment I will investigate the subjective information for this situation. The subjective information is as follows:

Chief Complaint (CC): “I have bumps on my bottom that I need to have looked at.”

History of Present Illness (HPI): AB, a 21-year-old white female, undergraduate student reports to the facility with outer bumps on her genital area. She expresses the bumps are not painful and feel rough. She states she is sexually active and has had in excess of one sexual partner over the previous year. Her underlying sexual contact happened at age 18. She reports no unusual vaginal release. She is uncertain to what extent the bumps have been there yet seen them about seven days prior. Her last Pap smear exam was three years prior, and no dysplasia was discovered; the exam results were ordinary. She reports one sexually transmitted disease (chlamydia) around two years back. She finished the treatment for chlamydia as endorsed. Assessing the Genitalia and Rectum Essay – Nursing 6512 – Week 10 Assignment.

Past Medical History (PMH): Asthma

Medications: Symbicort 160.4.5mcg

Allergies: NKA

Family History: Denies any history of breast/cervical cancer. Father has a history of HTN, and GERD.

Social History: Denies any tobacco or illicit drug use. She occasionally uses alcohol, she is married with 3 children (2 boys and 1 girl).

The subjective information displayed gives a clinical photo of the patient’s history. In the subjective part, a broad family history and patient history is important to decide a proper conclusion. (Raleigh, and Allan, 2017). At first, it is imperative to inquire as to whether she is up to date on her vaccinations and has ever had screening for Pap smears that were positive.  “Re-exposure inoculation is a standout amongst the best techniques for counteracting transmission of human papillomavirus (HPV), HAV, and HBV (Workowski, and Bolan,2015).

Furthermore, knowing who the health care provider that she has seen for the gynecology visit would be essential to assemble. Since she has a broad sexual history it would likewise be important to solicit whether any of her sexual partners were positive for STD’s and in the event that she has ever been tested for other STD’s. She expressed she was sure she had chlamydia however, data on STD treatment and screening is indispensable. Asking the patient when she last had sex and their identity would be critical on the off chance that the partner should be screened too. Exact risk evaluation and pre-exposure immunization of people in danger for antibody preventable STDs and also advising of sex accomplices of people tainted are fundamental. (Workowski, and Bolan, 2015).

Analysis of Objective Data

In this segment I will investigate the subjective information for this situation. The objective information is as follows:

VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

Heart: RRR, no murmurs

Lungs: CTA, chest wall symmetrical

Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia Assessing the Genitalia and Rectum Essay – Nursing 6512 – Week 10 Assignment

Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

Diagnostics: HSV specimen obtained.

The practitioner that played out this objective appraisal, completed a concise head to toe evaluation with a concentrated evaluation on the genital region. In any case, there are fundamental frameworks that are missing, for example, neurological and mental. This patient is a 21-year-old female and could conceivably show anxiety about this examination which could hinder her psychological status.

Likewise, playing out a head to toe skin evaluation and surveying the mucosa in her mouth would be fundamental. Completing a concentrated skin evaluation on the genital area is proper yet because of her broad sexual history. Additionally, body appraisal is justified as more ulcers could be found. “Essential aversion of STDs incorporates playing out an evaluation of social risks and additionally biologic hazard” (Workowski & Bolan, 2015).

What’s more, it is important to obtain a pregnancy test to guarantee that treatment would be proper if from an infectious reason. HSV sample is suitable however advance STD testing would be fitting.

Support/Refuse Assessment

In this part, I will bolster the evaluation information as suitable for diagnosing a chancre. Because of the area of the ulcers in the genitalia and the patient’s subjective manifestation of the chancre being painless, I would bolster the analysis of chancre. In any case, I invalidate the objective portion of this contextual investigation as a result of the information being absent as talked about earlier and because of the way that the diagnostics are insignificant. Since there are no outcomes from HSV testing or other demonstrative testing demonstrating an infectious source, it is suitable to determine the patient to have chancre.  “Non-infectious genital ulcers can be overseen by the health care provider with pain control and consolation” (DeLellis & Yen, 2017).

Diagnostic Tests

In this segment I will recommend fitting demonstrative tests and how each could be utilized to analyze this patient, as per the present literature.

In the patient’s objective information, HSV testing is fitting. This is fundamental to arrange when sores are available. HSV testing has a higher sensitivity level than a viral culture. As indicated by an investigation, the most elevated yield if vesicles can be unroofed and the base of a ulcer can be scratched with a Dacron swab, it will give the most exact information for diagnosing. Moreover, a type-specific serologic IgG measure would demonstrate current disease with HSV and STD screening. . On the off chance that this test would be negative, disease is still presumed, this test can be re-done in 6-12 weeks. The patient’s vital signs don’t recommend a fever but completing a CBC would be proper to surely preclude a contamination (Shah & Kantharia, 2017). Assessing the Genitalia and Rectum Essay – Nursing 6512 – Week 10 Assignment.

Differential Diagnoses

In this segment I will list somewhere around 3 conceivable findings, with contentions for accepting or dismissing each, as upheld by the present proficient literature.

Chancre

This differential finding is satisfactory in this patient’s case because of the way that the patient has bumps on her outer labia. Likewise, chancres are common in ladies who have numerous sexual partners. Portrayal of initial periods of syphilis incorporate the presence of a solitary chancre denotes the essential (first) phase of syphilis indications, yet there might be various wounds as this patient has in her labia (Mochtar, et al, 2017). The trademark presentation of a chancre is typically firm, round, and painless which is the thing that the patient reports subjectively. These chancres last about three to six week and heal in any case if the patient gets treatment. Be that as it may, if not treated, this can deteriorate into (Sexually Transmitted Diseases (STDs). Analytic testing for syphilis incorporate the accompanying: positive nontreponemal test (e.g., fast plasma reagin/Venereal Disease Research Laboratories titer, darkfield microscopy result) or a positive treponemal serology test. RPR test would demonstrate positive and would be affirmed by serology for Treponema pallidum (Mochtar, et al, 2017).

Chancroid

This differential finding is dismissed because of the way that chancroids present as a solitary profound ulcer and the patient expresses that it is excruciating. Besides, the patient would likewise grumble about a burning sensation on the ulceration which isn’t expressed above (Mochtar, et al, 2017). The patient’s current subject manifestations for the situation ponder states that the bumps are painless and feel rough. This information alone would reject the determination of chancroid. Assessing the Genitalia and Rectum Essay – Nursing 6512 – Week 10 Assignment. Furthermore, if a PCR was performed for diagnostics it would demonstrate Haemophilus ducreyi on a culture (Mochtar, et al, 2017).

Herpes Simplex Virus

This differential afinding would be rejected on the grounds that as per the contextual investigation the patient does not have tingling, burning without sores and basic manifestations seen of herpes labialis incorporate tingling and burning and afterward successive idevelopment of vesicular then ulcerative injuries that are in the oropharynx and perioral mucosa. There is no proof recommending that the patient has vesicular sores in her oropharynx or mucosa and the patient does not have subjective indications of ingling and burning (Mochtar, et al, 2017).

In conclusion, recognizable proof of 3 differential findings and the acknowledgment of the analysis of chancre was talked about in this paper. Intensive examination of subjective and objective information from this contextual analysis was talked about alongside suitable indicative tests. As health care providers, the way to proper diagnoses is stellar patient evaluation and emotional information accumulated from the past medicinal history.

 

 

 

References

DeLellis, D., & Yen, G. (2017). A Case of Non-infectious Genital Ulceration. 
Proceedings of UCLA Healthcare
, 
21
.

Kim, D. W., Kwak, H. B., Yun, S. K., Kim, H. U., & Park, J. (2016). P282: Mutiple oral and genital syphilic chancre. 
프로그램북
(
구

초록집
)
, 
68
(1), 400-401.

Mochtar, M., Murasmita, A., Irawanto, M. E., & Elistasari, E. Y. (2017). Genital Ulcers in Women with HIV Proposed Revision on Management Algoritm. 
American Journal of Life Sciences
, 
5
(3), 93-96.

Raleigh, M., & Allan, H. (2017). A qualitative study of advanced nurse practitioners’ use of physical assessment skills in the community: shifting skills across professional boundaries. 
Journal Of Clinical Nursing
, 
26
(13-14), 2025-2035. Assessing the Genitalia and Rectum Essay – Nursing 6512 – Week 10 Assignment

Sexually Transmitted Diseases (STDs). (2017, February 13). Retrieved from https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm

Shah , A.N., & Kantharia, B.K. (2017, January 23). 
Acute atrial fibrillation.
 
San Mateo, CA :

Epocrates, Inc..
 
Retrieved  August, 2, 2017 from www.epocrates.com

Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. 
MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports
, 
64
(RR-03), 1. Assessing the Genitalia and Rectum Essay – Nursing 6512 – Week 10 Assignment

NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

Week 9: Assessment of Cognition and the Neurologic System

               
NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST

The following list will be used to determine the grade for the physical examination demonstration.  It does not constitute a complete list of everything that could be included in a physical examination, but rather a list of those things that should be done at a minimum for every individual having a “complete physical examination”.

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IMPORTANT INSTRUCTIONS: Adjust your camera to show a full view of both you and your patient volunteer, show your government issued photo ID/passport for verification of who you are, scan the room that you are using for verification that notes are not being used or posted, then begin the video. You may not take notes during the examination. Omitting these instructions or obtaining a score of less than 69.5% will result in a failure of the video assignment and the course. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

Possible

Points

Score

Skin

2

Inspects all areas of body esp. feet

2

Head & Neck

6

Inspect & Palpates skull

1

Palpates lymph nodes for adenopathy

2

Palpates thyroid (with H2O/swallowing)

2

Palpates tracheal placement

1

Eyes

12

Checks visual acuity  (Snellen chart required)

1

Checks peripheral fields

2

Checks EOMs

2

Checks conjunctiva for pallor

1

Checks pupillary reaction

1

Opthalmoscopic exam (opthamoloscope is required)

5

describes discs, checks for microaneurysms,

hemorrhages, neovascularization

Ears, Nose,

Sinuses, Mouth 

Determines gross hearing/whisper test (Tuning Forks are required. Frequency of 500-1000Hz to be used)

2

8

Otoscopic exam (describes landmarks) (otoscope is required)

2

Inspect & Assess Nares

1

Palpate & percuss  sinuses

2

Examines mouth (hard palate/soft palate, salivary glands, tongue, gag reflex)

1

Chest and Lungs

8

Inspect chest & Observes respiratory movements

1

Posterior chest

5

Palpates & percuss respiratory excursion. Assess  tactile fremitus; Thoracic  expansion

Auscultates breath sounds

Anterior chest

2

Palpate & percuss ant chest. Auscultate breath sounds

Breasts

Explanation only –do not demonstrate

1

1

Palpates axillae, inspects breasts

Palpates axillary lymph nodes

Cardiovascular

8

Inspect & Observes neck veins and measures JVD (two pocket ruler required)

1

Palpates PMI and precordium

2

Auscultates cardiac sites (Aortic area, Pulmonic area, Tricuspid area, Mitral Area (Apex) and
state sounds

5

With diaphragm and bell sitting position

then diaphragm supine/left lateral decubitus

Peripheral Vascular

5

Inspect & Palpates pulses: carotids, radials, tibialis, pedals

2

Palpates for lower extremity edema

1

Auscultates for  carotid bruit

2

Abdomen

10

Inspect & Auscultates bowel sounds

1

Auscultates renal arteries

2

Percuss liver to determine span

NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

 

2

Palpates abdomen for tenderness(light and deep palpation, including McBurney’s point and rebound tenderness)

2

Check for splenic & liver enlargement

3

Neurological

30

Mental status—MMSE or clock drawing

1

Cranial nerves:

12

Olfactory: smell

Optic: visual acuity, fields

Oculomotor, trochlear, abduces: EOMs

Trigeminal: sensation & jaw strength

Facial: frown, smile, corneal reflex

Acoustic: gross hearing

Glossopharyngeal, vagus: gag reflex

Spinal accessory: shrug shoulders

Hypoglossal: moves tongue

Reflexes: all DTRs and Babinski (reflex hammer is required)

5

Sensory:

L ight touch/monofilament on feet (Monofilament tool required)

1

Vibration

1

Stereognosis or graphesthesia

1

Motor:

Strength—upper and lower extremities

2

Muscle tone

2

Gait

1

Cerebellar:

Test for coordination(any coordination test covered in your text readings)

1

One test for balance

1

One test for meningeal irritation

1

One test for nerve root irritation

1

Musculoskeletal

10

Inspects spine

1

Palpates spine

2

Palpates major joints

2

(Shoulders, Hips, Knees, Elbows)

Active ROM of spine, knee, shoulders, hips

5

Overall approach

-20 points for every editing/cut/paste in video

-20 points using notes or wall notes for each instance

-10 points if order is illogical or fragmented

-10 points for repeating the video due to not following instructions

–

-10  points for hesitation or evidence of lack of practice

-5 points for not wearing a lab coat AND professional dress attire

Video over 30 mins- video stopped at 30 mins and 10 points deducted in addition to point deductions for systems not covered. Faculty must watch the video to determine if all criteria were met to pass video.

–

Failure-  not using appropriate equipment;

Failure-  to perform a system assessment as this is a complete physical exam

Failure- not showing photo ID

Total

 

You MUST pass the video with 69.5% or higher or you will fail the course.

Comments:

A 63-year-old woman comes to your office because she’s been forgetting things…a young mother comes in concerned because her baby fails to make eye contact and is unresponsive to touch…a teenager comes in and a parent complains that the teen obsessively washes his hands.

An array of neurological conditions could be causing the above symptoms. When assessing the neurologic system, it is vital to formulate an accurate diagnosis as early as possible to prevent continued damage and deterioration of a patient’s quality of life. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

This week, you will explore methods for assessing the cognition and the neurologic system.

Learning Objectives – Week 9: Assessment of Cognition and the Neurologic System

Students will:

Evaluate abnormal neurological symptoms

Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for cognition and the neurologic system

Photo Credit: Kurt Drubbel/E+/Getty Images

Learning Resources – Week 9: Assessment of Cognition and the Neurologic System

Note:
 To access this week’s required library resources, please click on the link to the Course Readings List, found in the 
Course Materials
section of your Syllabus. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

Required Readings

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). 
Seidel’s guide to physical examination
 (8th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 5, “Mental Status” (64-78)This chapter revolves around the mental status evaluation of an individual’s overall cognitive state. The chapter includes a list of mental abnormalities and their symptoms.

Chapter 22, “Neurologic System” (pp. 544-580)The authors of this chapter explore the anatomy and physiology of the neurologic system. The authors also describe neurological examinations and potential findings.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). 
Advanced health assessment and clinical diagnosis in primary care
 (5th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 4, “Affective Changes” (pp. 33-46)This chapter outlines how to identify the potential cause of affective changes in a patient. The authors provide a suggested approach to the evaluation of this type of change, and they include specific tools that can be used as part of the diagnosis.

Chapter 9, “Confusion in Older Adults” (pp. 97-109)This chapter focuses on causes of confusion in older adults, with an emphasis on dementia. The authors include suggested questions for taking a focused history, as well as what to look for in a physical examination.

Chapter 13, “Dizziness” (pp. 148-157)Dizziness can be a symptom of many underlying conditions. This chapter outlines the questions to ask a patient in taking a focused history and different tests to use in a physical examination.

Chapter 19, “Headache” (pp. 221-234)The focus of this chapter is the identification of the causes of headaches. The first step is to ensure that the headache is not a life-threatening condition. The authors give suggestions for taking a thorough history and performing a physical exam. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

Chapter 28, “Sleep Problems” (pp. 345–355)In this chapter, the authors highlight the main causes of sleep problems. They also provide possible questions to use in taking the patient’s history, things to look for when performing a physical exam, and possible laboratory and diagnostic studies that might be useful in making the diagnosis.

Sullivan, D. D. (2019). 
Guide to clinical documentation
 (3rd ed.). Philadelphia, PA: F. A. Davis.

Chapter 2, “The Comprehensive History and Physical Exam” (“Cranial Nerves and Their Function” and “Grading Reflexes”; p. 29)

Chapter 4, “Pediatric Preventative Care Visits” (” Neurological Reflexes That Should Be Tested During Infancy”; (p. 108)

Chapter 9, “Prescription Writing and Electronic Prescribing” (pp. 195-206)

Note:
 Download and review these Adult Examination Checklists and Physical Exam Summary to use during your practice neurological examination.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for mental assessment. In 
Mosby’s guide to physical examination
 (7th ed.). St. Louis, MO: Elsevier Mosby. This Adult Examination Checklist: Guide for Mental Assessment was published as a companion to 
Seidel’s guide to physical examination
 (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for neurologic assessment. In 
Mosby’s guide to physical examination
 (7th ed.). St. Louis, MO: Elsevier Mosby. This Adult Examination Checklist: Guide for Neurologic Assessment was published as a companion to 
Seidel’s guide to physical examination
 (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Neurologic system. In 
Mosby’s guide to physical examination
 (7th ed.). St. Louis, MO: Elsevier Mosby. This Neurologic System Physical Exam Summary was published as a companion to 
Seidel’s guide to physical examination
 (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Bearden, S. T., & Nay, L. B. (2011). Utility of EEG in differential diagnosis of adults with unexplained acute alteration of mental status. 
American Journal of Electroneurodiagnostic Technology, 51
(2), 92–104. This article reviews the use of electrocenographs (EEG) to assist in differential diagnoses. The authors provide differential diagnostic scenarios in which the EEG was useful. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

Athilingam, P., Visovsky, C., & Elliott, A. F. (2015). Cognitive screening in persons with chronic diseases in primary care: challenges and recommendations for practice. American Journal of Alzheimer’s Disease & Other Dementias, 30(6), 547–558. doi:10.1177/1533317515577127. Retrieved from the Walden Library Databases.

Sinclair, A. J., Gadsby, R., Hillson, R., Forbes, A., & Bayer, A. J. (2013). Brief report: Use of the Mini-Cog as a screening tool for cognitive impairment in diabetes in primary care. Diabetes Research and Clinical Practice, 100(1), e23–e25. doi:10.1016/j.diabres.2013.01.001

Retrieved from the Walden Library Databases.

Roalf, D. R., Moberg, P. J., Xei, S. X., Wolk, D. A., Moelter, S. T., & Arnold, S. E. (2013). Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging. Alzheimer’s & Dementia, 9(5), 529–537. doi:10.1016/j.jalz.2012.10.001 Retrieved from http://www.alzheimersanddementia.com/article/S1552-5260(12)02463-6/abstract

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

This website provides an introduction to radiology and imaging. For this week, focus on head CTs in neuroradiology.

Required Media

Online media for 
Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 5 and 22 that relate to the assessment of cognition and the neurologic system. Refer to the Week 4 Learning Resources area for access instructions.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). 
DeGowin’s diagnostic examination
 (10th ed.). New York, NY: McGraw Hill Medical.

Chapter 14, “The Neurologic Examination” (pp. 683–765)This chapter provides an overview of the nervous system. The authors also explain the basics of neurological exams.

Chapter 15, “Mental Status, Psychiatric, and Social Evaluations” (pp. 766–786)In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process.

Mahlknecht, P., Hotter, A., Hussl, A., Esterhammer, R., Schockey, M., & Seppi, K. (2010). Significance of MRI in diagnosis and differential diagnosis of Parkinson’s disease. 
Neurodegenerative Diseases, 7
(5), 300–318. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

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.

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 Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

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

Post
 an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

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 9: Assessment of Cognition and the Neurologic System

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 9 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 9 Discussion

Assignment (Optional): Practice Assessment: Neurological Examination

Short of opening a patient’s cranium or requesting a brain scan, what can an advanced practice nurse do to determine the cause of neurological symptoms? A multitude of techniques can be used to generate a neurological diagnosis.

In preparation for the Head-to-Toe Physical Assessment Video due in Week 10, it is recommended that you practice performing a neurological examination this week.

Note:
 This is an 
optional
 practice physical assessment. You do not have to capture a video of this assessment, as no submission is required.

To prepare:

Arrange an appropriate time and setting with your volunteer “patient” to perform a neurological examination.

Download and review the Neurological Checklist provided in this week’s Learning Resources.

Ensure that you have a plexor (reflex hammer) to perform the examination.

To complete:

Perform the neurological examination. Be sure to cover all of the areas listed in the checklist and to use the plexor appropriately.

Looking Ahead: Head-to-Toe Physical Assessment Video

In 
Week 10
, you will videotape yourself conducting a head-to-toe physical assessment.

By Day 7 of Week 10

This video is due. Refer to Week 10 for additional guidance.

Week in Review

This week,
 you properly applied the assessment techniques and diagnoses for cognition and the neurological system. In addition, you evaluated abnormal neurological symptoms and explained which physical exams and diagnostic tests would render the appropriate results needed to make a diagnosis.

Next week,
you will explore how to assess problems with the breasts, genitalia, rectum, and prostate while making the patient feel safe, listened to and cared about using a non-invasive approach. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST

The following list will be used to determine the grade for the physical examination demonstration.  It does not constitute a complete list of everything that could be included in a physical examination, but rather a list of those things that should be done at a minimum for every individual having a “complete physical examination”.

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IMPORTANT INSTRUCTIONS: Adjust your camera to show a full view of both you and your patient volunteer, show your government issued photo ID/passport for verification of who you are, scan the room that you are using for verification that notes are not being used or posted, then begin the video. You may not take notes during the examination. Omitting these instructions or obtaining a score of less than 69.5% will result in a failure of the video assignment and the course.

Possible

Points

Score

Skin

2

Inspects all areas of body esp. feet

2

Head & Neck

6

Inspect & Palpates skull

1

Palpates lymph nodes for adenopathy

2

Palpates thyroid (with H2O/swallowing)

2

Palpates tracheal placement

1

Eyes

12

Checks visual acuity  (Snellen chart required)

1

Checks peripheral fields

2

Checks EOMs

2

Checks conjunctiva for pallor

1

Checks pupillary reaction

1

Opthalmoscopic exam (opthamoloscope is required)

5

describes discs, checks for microaneurysms,

hemorrhages, neovascularization

Ears, Nose,

Sinuses, Mouth 

Determines gross hearing/whisper test (Tuning Forks are required. Frequency of 500-1000Hz to be used)

2

8

Otoscopic exam (describes landmarks) (otoscope is required)

2

Inspect & Assess Nares

1

Palpate & percuss  sinuses

2

Examines mouth (hard palate/soft palate, salivary glands, tongue, gag reflex)

1

Chest and Lungs

8

Inspect chest & Observes respiratory movements

1

Posterior chest

5

Palpates & percuss respiratory excursion. Assess  tactile fremitus; Thoracic  expansion

Auscultates breath sounds

Anterior chest

2

Palpate & percuss ant chest. Auscultate breath sounds

NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST

Breasts

Explanation only –do not demonstrate

1

1

Palpates axillae, inspects breasts

Palpates axillary lymph nodes

Cardiovascular

8

Inspect & Observes neck veins and measures JVD (two pocket ruler required)

1

Palpates PMI and precordium

2

Auscultates cardiac sites (Aortic area, Pulmonic area, Tricuspid area, Mitral Area (Apex) and
state sounds

5

With diaphragm and bell sitting position

then diaphragm supine/left lateral decubitus

Peripheral Vascular

5

Inspect & Palpates pulses: carotids, radials, tibialis, pedals

2

Palpates for lower extremity edema

1

Auscultates for  carotid bruit

2

Abdomen

10

Inspect & Auscultates bowel sounds

1

Auscultates renal arteries

2

Percuss liver to determine span

 

2

Palpates abdomen for tenderness(light and deep palpation, including McBurney’s point and rebound tenderness)

2

Check for splenic & liver enlargement

3

Neurological

30

Mental status—MMSE or clock drawing

1

Cranial nerves:

12

Olfactory: smell

Optic: visual acuity, fields

Oculomotor, trochlear, abduces: EOMs

Trigeminal: sensation & jaw strength

Facial: frown, smile, corneal reflex

Acoustic: gross hearing

Glossopharyngeal, vagus: gag reflex

Spinal accessory: shrug shoulders

Hypoglossal: moves tongue

Reflexes: all DTRs and Babinski (reflex hammer is required)

5

Sensory:

L ight touch/monofilament on feet (Monofilament tool required)

1

Vibration

1

Stereognosis or graphesthesia

1

Motor:

Strength—upper and lower extremities

2

Muscle tone

2

Gait

1

Cerebellar:

Test for coordination(any coordination test covered in your text readings)

1

One test for balance

1

One test for meningeal irritation

1

One test for nerve root irritation

1

Musculoskeletal

10

Inspects spine

1

Palpates spine

2

Palpates major joints

2

(Shoulders, Hips, Knees, Elbows)

Active ROM of spine, knee, shoulders, hips

5

Overall approach

-20 points for every editing/cut/paste in video

-20 points using notes or wall notes for each instance

-10 points if order is illogical or fragmented

-10 points for repeating the video due to not following instructions

–

-10  points for hesitation or evidence of lack of practice

-5 points for not wearing a lab coat AND professional dress attire

Video over 30 mins- video stopped at 30 mins and 10 points deducted in addition to point deductions for systems not covered. Faculty must watch the video to determine if all criteria were met to pass video.

–

Failure-  not using appropriate equipment;

Failure-  to perform a system assessment as this is a complete physical exam

Failure- not showing photo ID

Total

 

You MUST pass the video with 69.5% or higher or you will fail the course.

NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST

 

Comments:

NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

Question 1

Which of the following factors is not known to affect patient compliance with his or her treatment regimen?

 

Response Feedback:

The controlling factors of compliance include the nature of the relationship you have developed, your recognition of the patient s autonomy, your success in communicating the basics of the patient s condition, and the clarity of your instructions. Always ask the patient to repeat the instructions to you to make sure they are understood. Equally important factors are the patient s ability to understand the problem and the value the patient places on resolving the problem.

Question 2

One of the most important aspects to consider in the orthopedic screening examination is:

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Response Feedback:

The most important aspect to consider when conducting an orthopedic examination is to look for symmetry of muscle, stature, and joint movement.

Question 3

The sequence of the physical examination should be individualized to:

 

Response Feedback:

There is no one right way to put together the parts of the physical examination. The sequence should be individualized to minimize the number of times the patient has to change positions to conserve the patient s energy.

Question 4

As you greet the patient, which examination technique is first implemented?

 

Response Feedback:

Begin to inspect the patient as you greet them, as you look for signs of distress or disease. Inspect their appearance, gait, orientation, and difficulty in hearing or speech.

Question 5

Which of the following is most likely to enhance examiner reliability? NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

 

Response Feedback:

The examiner may not always be correct, but questioning yourself and seeking confirmation from others when necessary will serve to assure your reliability. A person should never be prejudged because this can interfere with your examination and findings. Showing that you are uncomfortable with your skills can make the patient feel uncomfortable and see you as unreliable. The use of unselective technology should not substitute for a well-honed history and physical.

Question 6

Premature infant respiratory distress is often manifested by:

 

Response Feedback:

Respiratory distress of premature infants is indicated by a sustained increased rate, grunting, retraction of intercostal and subcostal spaces and suprasternal notch, seesaw sinking of the chest with rising abdomen in contrast to the normal synchronous motions, and flaring nose. The other choices are not expected findings in premature infants.

Question 7

A common method of estimating gestational age of a newborn is to assess:

 

Response Feedback:

To determine gestational age, look at the soles of the feet. Before 36 weeks gestation, only one or two transverse creases are present; by 40 weeks gestation, many creases are present on the soles of the feet. Other clues to gestational age include breast nodule less than 3 cm, cartilage in the helix of the ear, descending of the scrotum and amount of rugae, and extremities in flexed positions.

Question 8

Proprioception should be assessed while the patient is:

 

Response Feedback:

Proprioception examination involves the Romberg test, heel-to-toe walking, standing on one foot and then on the other with eyes closed, hopping in place, and deep knee bends. The standing position is required to conduct these examinations.

Question 9

The examination of the newborn should begin with:

 

Response Feedback:

The examination of a newborn should begin with inspection noting skin color, flaccidity, tension, gross deformities, or distortions of facies. All of the other examination techniques follow inspection.

Question 10

When assessing the abdomen, one needs to expose the patient:

 

Response Feedback:

While the patient is in the supine position, the examiner can assess the abdomen. Arrange draping to expose the abdomen from pubis to epigastrium, ensuring to cover the private areas of the patient. All of the other options would not allow for a thorough inspection and examination or they would expose the patient inappropriately.

Question 11

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

 

Response Feedback:

Functional assessment is most important when examining the older adult. Initial observation and interaction can provide a great deal of information about the individual s independent functional capacity. Attention should be given to self-care activities and instrumental activities.

Question 12 NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

The goals of preparticipation sports evaluation include:

 

Response Feedback:

The ultimate goal of preparticipation physical evaluation is to ensure safe participation in an appropriate sports activity. A preparticipation evaluation may not predict a brain injury and concussion, but it can help you learn the normal neuropsychologic status of the person involved before injury.

Question 13

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

 

Response Feedback:

Duck walking for four steps assesses hip, knee, and ankle range of motion, strength, and balance.

Question 14

You are conducting a preparticipation physical examination for a 10-year-old girl with Down syndrome who will be playing basketball. She has slight torticollis and mild ankle clonus. What additional diagnostic testing would be required for her?

 

Response Feedback:

This girl is experiencing symptoms of atlantoaxial joint instability and should therefore have a cervical spine radiograph with neurologic consultation before beginning sports activities.

Question 15

An ophthalmoscopic eye examination involves:

 

Response Feedback:

Ophthalmoscope eye examination involves testing the red reflex and inspecting the lens, disc, cup margins, vessels, and retinal surface. The other assessments do not involve the use of the ophthalmoscope.

Question 16

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

 

Response Feedback:

The patient is a full partner with the examiner. The examiner should keep the patient informed and should develop a relationship to ensure trust. Cultural issues should be acknowledged, not ignored. Clinical judgment can allow deviations from rigid structures and allow adaptations to a particular circumstance.

Question 17

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

 

Response Feedback:

The best way to ease the apprehension of a 3-year-old child before a physical examination is to encourage the child to participate by helping you. Ask the child to hold the end piece of the stethoscope or to blow out your flashlight.

Question 18

Which one of the following patient characteristics is most likely to limit patient reliability during history taking?

 

Response Feedback:

A partial or total loss of any of the senses can limit a patient s reliability as a historian. Emotional constraints, language barriers, cultural barriers, and an unresponsive or comatose patient can all affect a patient s ability to be a thorough historian. All of the other options would not limit a patient s reliability.

Question 19

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

 

Response Feedback:

The newborn is at greater risk for potential health problems than other ages but also has the potential for better health than the other age groups.

Question 20

To inspect the abdominal muscles, ask the:

 

Response Feedback:

Asking the patient to raise the head will contract the rectus abdominis muscles, which produces muscle prominence, making abdominal wall masses visible. All of the choices would not show the abdominal muscles contracting.

 

Question 1

A therapeutic technique for dealing with grieving individuals is to:

Response Feedback:

When a patient dies, the grieving family and friends need attention for their emotional needs. It is often difficult to find words, and often the words may be cliché and not seem appropriate for the moment. It is all right to tell them that it is good to cry and to share feelings. It is permissible to talk about what has been lost and what will not be realized for the future. All of the other answers are not therapeutic for a grieving family member or friend.

Question 2

The examination of the newborn should begin with:

Response Feedback:

The examination of a newborn should begin with inspection noting skin color, flaccidity, tension, gross deformities, or distortions of facies. All of the other examination techniques follow inspection.

Question 3

Which one of the following patient characteristics is most likely to limit patient reliability during history taking?

Response Feedback:

A partial or total loss of any of the senses can limit a patient s reliability as a historian. Emotional constraints, language barriers, cultural barriers, and an unresponsive or comatose patient can all affect a patient s ability to be a thorough historian. All of the other options would not limit a patient s reliability.

Question 4

In crying infants, it is often difficult to:

Response Feedback:

For the crying infant, lungs can be auscultated between consolable moments. While crying, the examiner can assess the lustiness of cry, tactile fremitus, lung excursion, facial symmetry, and appearance of the mouth and pharynx. Between breaths, heart tone can be auscultated.

Question 5

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

Response Feedback:

The patient is a full partner with the examiner. The examiner should keep the patient informed and should develop a relationship to ensure trust. Cultural issues should be acknowledged, not ignored. Clinical judgment can allow deviations from rigid structures and allow adaptations to a particular circumstance. NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

Question 6

Which of the following are examined with the patient in a reclining 45-degree position?

Response Feedback:

With the patient in a reclining 45-degree position, you can examine jugular venous pulsations and measure jugular venous pressure. All of the other choices can be examined with the patient in a sitting position.

Question 7

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

Response Feedback:

The newborn is at greater risk for potential health problems than other ages but also has the potential for better health than the other age groups.

Question 8

Examination of the patient in the lithotomy, or knee-chest, position includes:

Response Feedback:

With the patient in the lithotomy position, the examiner can inspect the external and internal female genitalia and perform rectal examination to assess and palpate anal sphincter tone. The other answers require the patient to be in the supine or standing position.

Question 9

Which portion of the physical examination is best done with the patient standing?

Response Feedback:

With the patient in the standing position, the examiner can inspect and palpate the spine as the patient bends over at the waist and test a patient s range of motion.

Question 10

A parent is advised to restrict contact or collision sports participation for their child. An example of a sport in which this child could participate is:

Response Feedback:

Hockey and diving are considered a contact or collision sport; roller skating and skateboarding are considered to be limited-contact sports. Track is a noncontact sport.

Question 11

One of the most important aspects to consider in the orthopedic screening examination is:

Response Feedback:

The most important aspect to consider when conducting an orthopedic examination is to look for symmetry of muscle, stature, and joint movement.

Question 12

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

Response Feedback:

Functional assessment is most important when examining the older adult. Initial observation and interaction can provide a great deal of information about the individual s independent functional capacity. Attention should be given to self-care activities and instrumental activities.

Question 13

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

Response Feedback:

At the checkout station, data collected during the evaluation are reviewed and necessary follow-up actions are shared with the athlete and/or parents. In addition, the written report is distributed. If the PPE is not itself a comprehensive service that addresses issues unrelated to sports participation, the need for routine primary care remains.

Question 14 NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

A common method of estimating gestational age of a newborn is to assess:

Response Feedback:

To determine gestational age, look at the soles of the feet. Before 36 weeks gestation, only one or two transverse creases are present; by 40 weeks gestation, many creases are present on the soles of the feet. Other clues to gestational age include breast nodule less than 3 cm, cartilage in the helix of the ear, descending of the scrotum and amount of rugae, and extremities in flexed positions.

Question 15

Palpation of epitrochlear nodes is part of the:

Response Feedback:

Palpation of epitrochlear nodes is part of the examination of the upper extremities. To palpate the epitrochlear nodes, support the elbow in one hand and palpate in the depression above and posterior to the medial condyle of the humerus.

Question 16

Observation of the child playing in the playroom provides information about which two systems?

Response Feedback:

The child playing on the floor offers an opportunity to evaluate both the musculoskeletal and neurologic systems by noting the child s coordination of activities, such as when throwing a ball, drawing, coloring, walking, and jumping.

Question 17

As you greet the patient, which examination technique is first implemented?

Response Feedback:

Begin to inspect the patient as you greet them, as you look for signs of distress or disease. Inspect their appearance, gait, orientation, and difficulty in hearing or speech.

Question 18

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

Response Feedback:

Duck walking for four steps assesses hip, knee, and ankle range of motion, strength, and balance.

Question 19

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

Question 20

The sequence of the physical examination should be individualized to:

Response Feedback:

There is no one right way to put together the parts of the physical examination. The sequence should be individualized to minimize the number of times the patient has to change positions to conserve the patient s energy. NURS 6512 Health Assessment, Week 11 Quiz, Neuro/Spinal/Muscles

Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Assessing the Genitalia and Rectum

Episodic/Focused SOAP Note Template

Patient Information:

JW       Age: 21         Sex: Female                 Race: Caucasian

S.

BUY A PLAGIARISM-FREE PAPER HERE

CC
(chief complaint) “I have bumps on my bottom that I want to have checked out. ”

HPI
:  This 21-year-old Caucasian female presents to our clinic complaining of painless, rough bumps on her genital region.  The onset of these bumps was approximately one week ago.  JW reports being sexually active with more than one partner over the past year.  She also has a history of chlamydia 2 years ago with completed treatments.  She reports being sexually active since the age of 18 years of age.

Current Medications
:  Symbicort 160/4.5mcg PO twice daily

Allergies:
NKDA

PMHx
: Chlamydia, Asthma

Soc Hx
: Denies tobacco use; occasional ETOH, married, 3 children (1 girl, 2 boys)

Fam Hx
:  No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

ROS
:

Example of Complete ROS:

GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose or sore throat. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

SKIN:  Reports bumps on around genital region, no vaginal discharge reported.

CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. Denies palpitations or edema.

RESPIRATORY:  Denies shortness of breath, cough or sputum.

GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Denies urinary symptoms. LMP: 03/22/18. Last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. Denies change in bowel or bladder control.

MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  Denies anemia, bleeding or bruising.

LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety.

ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  history of asthma;  denies hives, eczema or rhinitis.

O.

VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

General:  
Awake, alert, and oriented x4 female.  She is well groomed and well-nourished.  Denies fever, chills, fatigue, nausea, and vomiting.

Cardiovascular:  +
S1, S2, heart rate and rhythm regular, no murmur, no peripheral edema observed.

Respiratory: 
CTA, chest wall symmetrical

Gastrointestinal:
Abdomen
 
soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

Genitourinary: 
Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

Diagnostic results
:  HSV results pending

A
.

Differential Diagnoses 

1)
Human Papilloma Virus (HPV)  
HPV infection commonly causes warts. Some  HPV infections may cause cervical cancers. There are more than 100 varieties of HPV (Hammer & McPhee, 2014).  Most HPV infections will not lead to cancer. However, some types of genital HPV may cause cervical cancer (Hammer & McPhee, 2014).  HPV may be responsible for cancers of the anus, penis, vagina, vulva, and oropharyngeal. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Signs and Symptoms

The body’s immune system combats  HPV before creating warts.  When warts appear, they vary in appearance depending on the type of HPV involved: genital warts, common warts, plantar warts, and flat warts (Hammer & McPhee, 2014).  Genital warts in women appear mostly on the vulva but may also appear near the anus, cervix, and vagina.

Risk Factors

An increased amount of sexual partners makes it more likely to contract HPV.  Genital warts are most common in adolescents and young adults (Hammer & McPhee, 2014).  Patients with a weakened immune system are at greater risk of HPV.  Exposed areas of skin that have been punctured or opened are at risk of developing common warts (Hammer & McPhee, 2014).

Diagnostic Tests

The following tests may be recommended if the genital warts are not visible.

Acetic acid solution test
consists of a vinegar solution applied to HPV-infected genital areas and turns these areas white (Hammer & McPhee, 2014).

Pap Smear 
consists of a clinician collecting a sample of cells from the cervix or vagina to send for laboratory analysis. A Pap test may be able to reveal abnormal cells that may lead to cancer (Hammer & McPhee, 2014).

DNA test
consists of analyzing cells from a patient’s cervix and is able to recognize DNA that is considered high-risk of HPV and linked to genital cancers (Hammer & McPhee, 2014).

 

2)
Genital Herpes:  
A  sexually transmitted infection (STI) caused by the herpes simplex virus (HSV) (Goljan, 2014).  The virus is primarily transmitted sexually.  The virus typically lies dormant and may emerge several times a year (Goljan, 2014).

Signs and Symptoms

Symptoms may begin between two to 12 days after exposure to HSV.  Symptoms if present may include:

Pain or itching in the genital region

Red bumps or white blisters

Ulcers that may ooze or bleed

Scabs (Goljan, 2014).

 

During the initial outbreak,  flu-like symptoms may present such as swollen lymph nodes in the groin, headache, muscle aches, and fever (Goljan, 2014). Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Risk Factors

The risk of becoming infected with genital herpes may increase the patient:

Is Female.  The mode of transportation is much easier from men to women than it is women to men.

Multiple sexual partners (Goljan, 2014).

 

Diagnostic Tests

A clinician may diagnose genital herpes by the physical examination along with the results of some of the following lab results:

Viral culture of the sore

Polymerase chain reaction (PCR) test

HSV antibody test. This test may detect past infection of HSV (Goljan, 2014).

 

3) 
Bartholin’s cyst:  
The Bartholin’s glands are located on each side of the vaginal opening and secreted fluid that helps lubricate the vagina (McCance , Huether, Brashers, & Rote, 2014).  When the openings of the Bartholin’s glands become obstructed, fluid will back up into the gland.  This will result in a painless swelling called the Bartholin’s cyst (McCance et al., 2014).  The fluid within the cyst may become infected and collect pus which will develop into an abscess (McCance et al., 2014).

Signs and Symptoms

The cyst may present as a lump or mass near the vaginal opening.  The cyst may usually be painless, it can be tender.  When a cyst is infected the following symptoms may be present:

A tender, painful lump near the vaginal opening

Discomfort while walking or sitting

Pain during intercourse

Fever (McCance et al., 2014).

 

Diagnostic Tests

Diagnosing a Bartholin’s cyst may be possible by acquiring a thorough health history, performing a pelvic exam, obtaining a sample of secretions from the vagina to r/o STIs, and biopsy of the mass for women over 40 years of age (McCance et al., 2014). 
 

4)
Sebaceous cyst:   
Cysts are abnormalities in the body that contain noncancerous liquid material (McCance et al., 2014).  These cysts are mostly found on the face, neck, or torso.  Their growth is slow and is not life-threatening, but they may become uncomfortable if left untreated (McCance et al., 2014). Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Signs and Symptoms

Small cysts are typically not painful.  Large cysts can range from uncomfortable to painful.  Large cysts on the face and neck cause pressure and pain.  The areas on the body where cysts are usually found include the scalp, face, neck, and back (McCance et al., 2014).

Diagnostic Tests

The clinician is able to diagnose a sebaceous cyst during the physical examination. If the cyst is seen as unusual, the clinician may order tests to rule out cancer.  The most common tests used for a sebaceous cyst include:  CT scans for a possible surgical route, ultrasounds for the internal structure of cyst, and biopsy (McCance et al., 2014).

5)
Syphilis:  
A bacterial infection primarily spread sexually.  It presents as a painless sore on the genitals, rectum or mouth (Hammer & McPhee, 2014).  Syphilis may spread via skin or mucous membrane contact with these sores  (Hammer & McPhee, 2014).  Post initial infection, syphilis can remain dormant for several decades before resurfacing.  Early treatment may rid the infection with antibiotics, however, when left untreated it can severely damage the heart, brain, and can be life-threatening, and maybe also passed from mother to unborn child (Hammer & McPhee, 2014).

Signs and Symptoms

Syphilis may present in different stages which may overlap at times.  The stages include:  primary syphilis, secondary syphilis, latent syphilis, tertiary syphilis, and congenital syphilis (Hammer & McPhee, 2014).

Primary syphilis:  
The first sign of syphilis is a small sore that appears at the spot where the bacteria entered the body.  This sore is also called a chancre.  The sore develops about three weeks after exposure, is usually painless and hidden within the vagina or rectum (Hammer & McPhee, 2014) .

Secondary syphilis:  
Within a few weeks of healing the patient may experience a rash that begins on the trunk and may eventually cover the entire body including the palms of the hands and soles of the feet (Hammer & McPhee, 2014).  The rash is usually not itchy and may be accompanied by wart-like sores in the mouth or genital area (Hammer & McPhee, 2014).

Latent syphilis
:  If left untreated the infection may be dormant for several years or never return.

Tertiary syphilis:  
This is considered the late stage of syphilis, the disease may damage the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints (Hammer & McPhee, 2014). Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

 

Risk Factors

Unprotected sex

Multiple sexual partners

Homosexual man engaging in sex with other men

Patient infected with HIV (Hammer & McPhee, 2014)

 

Diagnostics

Serum 
tests can confirm the presence of antibodies that the body produces to fight infection (McCance et al., 2014).  The antibodies to the bacteria that cause the infection remain in the body for years, therefore the test can be used to determine a current or past infection (McCance et al., 2014).

Cerebral spinal fluid.
If it’s suspected that the nervous system has been compromised by syphilis a lumbar puncture may be recommended.

 

References

Goljan, E. F. (2014).
Rapid review: Pathology
(4th ed.). Philadelphia, PA: Elsevier.

Hammer, G. D., & McPhee, S. J. (2014).
Pathophysiology of disease: An introduction to clinical medicine
(7th ed.). China: McGraw Hill.

McCance , K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014).
Pathophysiology: The biologic basis for disease in adults and children
(7th ed.). St. Louis, MS: Elsevier.

 

Assessing The Genitalia And Rectum

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

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

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

GENITALIA ASSESSMENT

Subjective:

CC: “I have bumps on my bottom that I want to have checked out.”

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

PMH: Asthma

Medications: Symbicort 160/4.5mcg

Allergies: NKDA

FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

Heart: RRR, no murmurs

Lungs: CTA, chest wall symmetrical

Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

Diagnostics: HSV specimen obtained

Assessment:

Chancre

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

To prepare:

With regard to the SOAP note case study provided:

Review this week’s Learning Resources, and consider the insights they provide about the case study.

Consider what history would be necessary to collect from the patient in the case study.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Identify 
at least five
 possible conditions that may be considered in a differential diagnosis for the patient.

To complete:

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

Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Analyze the objective portion of the note. List additional information that should be included in the documentation. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Is the assessment supported by the subjective and objective information? Why or Why not?

Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from the current evidence-based literature. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Episodic/Focused SOAP Note Template Examples

Patient Information:

Initials  Age, Sex, Race

S.

CC
(chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

HPI
: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example: Episodic/Focused SOAP Note Template Examples.

BUY A PLAGIARISM-FREE PAPER HERE

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Current Medications
: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

Allergies:
include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

PMHx
: include immunization status (note date of
last tetanus
for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

Soc Hx
: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system. Episodic/Focused SOAP Note Template Examples.

Fam Hx
: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

ROS
: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows:
General:

Head
:
EENT
: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL:  No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat. Episodic/Focused SOAP Note Template Examples.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising. Episodic/Focused SOAP Note Template Examples.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis.

O.

Physical exam
: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History.
Do not use “WNL” or “normal.” You must describe what you see.
Always document in head to toe format i.e. General: Head: EENT: etc.

Diagnostic results
: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines) Episodic/Focused SOAP Note Template Examples.

A
.

Differential Diagnoses
(list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.

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

References

You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6
th
edition formatting.

 

 

Episodic/Focused SOAP Note Template – Episodic/Focused SOAP Note Template Examples 2

 

Patient Information:

L., 20, F, Caucasian

SUBJECTIVE.

CC:
“I have been having sore throat for three days, and I also have decreased appetite, headache, and pain with swallowing.”

HPI
: Ms. L is a 20-year-old female college student who presents with sore throat for three days, with additional decreased appetite, headache, and pain with swallowing. She recounts that similar “flu-like” symptoms recently affecting multiple students on campus. Ms. L also noted runny nose and a slight hoarseness in her voice but doesn’t sound congested. She took Tylenol and Chloraseptic lozenges, but did little for relief. Episodic/Focused SOAP Note Template Examples.

Location:
throat

Onset:
3 days ago

Character:
throat is sore

Associated signs and symptoms
: decreased appetite, headache, and pain with swallowing.

Timing
: constant

Exacerbating/ relieving factors
: light bothers eyes, Tylenol makes it tolerable but not completely better.

Severity:
8/10 pain scale

Problem-Specific Questions
:

Have you been coughing? Any drainage or phlegm? Is it productive, if so how much? What is the color of the phlegm?

Have you been running a fever or exhibiting chills?

Are you taking any medications for this? Are they helping?

Are you having any pain or pressure in your face, head, or sinuses? Have you recently had a head injury? Any nasal bleeding noted?

Do you smoke or have you been around anyone who smokes?

Do you experience gastroesophageal reflux or heartburn?

Does it hurt to swallow solids, liquids, or both?

Do you feel like something is stuck in your throat? Episodic/Focused SOAP Note Template Examples.

Do you cough or choke when swallowing?

Do you have any changes in your appetite? Did it start with the onset of your sore throat?

Any changes in your weight? Did you lose or gain weight?

What have you eaten in the last twenty-four hours?

Have you had any nausea or vomiting?

Current Medications
: Multivitamins 1 tablet daily; and Blisovi Fe 1/20 1 tab daily

Allergies:
Penicillin (Hives)

PMHx
: No pertinent medical history reported, it is unremarkable. No recent hospitalizations reported in the past. Immunizations are current. Last tetanus shot was taken June 2010. Last flu shot was taken September 2016. Denies any history of accidents/injury or falls.

Soc Hx
: Ms. L was born in Galveston, TX, and currently attends a community college at Houston Community College – Katy Campus. She attends classes Mon-Fri from 8am to 3pm. She works at daycare center on the weekends while in school, and during the week on Summer break. She is Single, and heterosexual. She is in a monogamous relationship with her boyfriend, and sexually active. She exercises 3x/week, and eats a diet consisting of meat/fish, vegetables, fruits, rice and beans. She drives a vehicle, and always put on her seatbelt. She is a social drinker, takes 1-2 glasses of wine every 2 weeks. Never smoked, and denies use of illicit/recreational drugs. Drinks green tea daily.

Fam Hx
:

Maternal Grandmother
: deceased at age 83 related to Stroke

Maternal Grandfather:
deceased at age 98, no health conditions noted

Paternal Grandmother:
deceased at age 38, post-partum hemorrhage

Paternal Grandfather:
deceased at age 102 related to uncontrolled HTN

Mother:
age 57, No health conditions reported Episodic/Focused SOAP Note Template Examples

Father:
age 63, has Arthritis, and HTN

Siblings:
She has 2 sisters age 18 and 16. Both are alive and well, no health conditions reported

Review of Systems
:

GENERAL:  The patient is awake, alert, oriented and appears generally well. See HPI.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclera. No decreased hearing. No hearing loss, sneezing, or congestion. Has complaints of runny nose, sore throat, headaches, and hoarse voice.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  Respirations are regular and unlabored. No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood. Complaints of decreased appetite

GENITOURINARY:  Denies burning in urination, never been pregnant. Menses are regular, last menstrual period, 05/28/2017.

NEUROLOGICAL:  No dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. Complains of headache that started with the onset of sore throat.

MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness. Episodic/Focused SOAP Note Template Examples.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No history of splenectomy. Swollen nodes in the neck

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  Allergic to PCN, gives her hives.

OBJECTIVE.

Physical exam
: The patient is awake, alert, oriented and appears generally well. The patient is in no distress. Vital signs revealed a Ht. 5’10”, Wt. 150 lbs; BMI= 21.5; pulse of 96, respirations of 18, temperature of 101.6 and O2 saturation on room air of 98%. HEENT: Pupils are equal, round and reactive to light. There is no sinus tenderness. Ears are clear. Throat is slightly red with some swelling and exudate. Neck is supple with anterior cervical lymphadenopathy. Note runny nose and hoarse voice. Lungs are clear. Heart has regular rate and rhythm without murmur or gallop. Back showed no CVA tenderness. Abdomen is soft and non-tender. No organomegaly. Extremities: No edema or tenderness. Skin/Hair/Nails: Normal color for ethnicity and turgor without rash.

Diagnostic results
: CBC and CMP ordered; throat swab was obtained and sent to the lab for rapid strep testing, rapid influenza diagnostic testing, and follow-up throat culture.

ASSESSMENT
.

Differential Diagnoses

Influenza
: Patient is exhibiting classic signs of sore throat, fever, headache, and nasal discharge (National Foundation for Infectious Diseases, 2016), with exposure to multiple infectious sources on her close-quartered college campus, this condition may be likely pending diagnostics.

Group A streptococcal pharyngitis
: I would consider this due to her sore throat, but would need to visualize her mouth and throat to observe for possible erythematous and exudative tonsils and uvula, as well as other symptoms common to this diagnosis (Vincent et al, 2004). Episodic/Focused SOAP Note Template Examples.

Diphtheria
: Common clinical manifestation includes low grade fever, sore throat, headache, malaise, and hoarseness (Centers for Disease Control and Prevention, 2016), very similar to my patient’s symptoms. However, this may be unlikely in United States as most people are vaccinated, though still prevalent in developing countries. In addition, Children under 5 and adults over 60 years old are particularly at risk for contracting the infection.

Epiglottitis
: Because of her sore throat and vocal changes, this should be ruled out as it can advance to emergent airway obstruction, however, my suspicions would tell me that this is not probable as these patients often present in respiratory distress and it is a potentially life-threatening illness. This condition is historically a condition more common in children, but it is becoming more frequent in adults. It requires prompt diagnosis and treatment in anyone, but especially in children, who are more vulnerable to breathing complications (Marcin, 2017).

Epstein-Barr virus (EBV) infectious mononucleosis
: Typically, these viruses spread most commonly through bodily fluids, especially saliva. Though classic signs of EBV is prolonged malaise, sore throat is a very prevalent sign, and the condition more common for those between ages 15-30 years, and close quarters being a common factor for transmission (Vincent et al, 2004), however, EBV should also be ruled out due to short time onset, and no enlarged spleen or liver noted.

PLAN.

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

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).
Seidel’s guide to physical examination
(8th ed.). St. Louis, MO: Elsevier Mosby.

Centers for Disease Control and Prevention (2016). About Diphtheria. Retrieved from

https://www.cdc.gov/diphtheria/about/index.html Episodic/Focused SOAP Note Template Examples

 

Marcin, J. (2017). Epiglottis. Retrieved from

http://www.healthline.com/health/epiglottitis#overview1

 

National Foundation for Infectious Diseases (2016). Influenza (Flu). Retrieved from

http://www.nfid.org/idinfo/influenza

 

Vincent, M., et al (2004). Pharyngitis. Retrieved from

http://www.aafp.org/afp/2004/0315/p1465.html Episodic/Focused SOAP Note Template Examples