Category: Nursing

NR 601 Week 5 Case Study Discussion

NR 601 Week 5 Case Study Discussion – Part One

NR 601 Week 5 Case Study Discussion – Part One – C.W. is a tall, thin 78-year-old African American male brought into the office by his son who states that the patient is restless, angry, and has been unable to sleep for the last week. The son indicates that he is very concerned about his father because he lives alone. Also, he is concerned about the “strange” symptoms that his father has presented with recently.

 Background: 

C.W. presents as restless, hyperverbal, obnoxious and angry. He expresses himself byperiodic yelling. He is unkempt and smells strongly of urine, alcohol and body odor. ………… has an unsteady gait and sways while standing. As you converse with the son, you determine that C.W. was medically separated from military service due to mental health issues after 2 years of active duty that ended in 1947. He has been married and divorced three times over the years. He typically seeks no acute or preventative medical care. ___ was treated by a psychiatrist previously, but he did not like taking the prescribed medications so he stopped taking them and did not keep any further psychiatric appointments. NR 601 Week 5 Case Study Discussion.

 PMH:

Patient denies any previous diagnoses. However, when asked why he saw a psychiatrist in the past, he tells you that the psychiatrist diagnosed paranoid schizophrenia, but that he does not have any psychiatric diagnoses or problems. He states: “It was just a way for him to make money off me coming in and seeing him and paying the drug companies for me to take all those meds!”

Current medications: 

Denies prescription medications, over the counter medication, herbal therapies or vitamins.

Surgeries:

Denies surgeries

Allergies: NKA

Vaccination History:

Flu vaccine: never given

Pneumovax: never given

Tetanus: never given

Herpes zoster: never given

Screening History:

Last Colonoscopy was 2012-normal

Last dilated retinal and glaucoma exam was 2013

 Social history and Risk Factors:

Patient admits to smoking cigarettes and cigars. …… estimates that he smokes about 1 pack of cigarettes daily for the last 40 years, and 2 cigars each week for the last 30 years.

He states that he drinks a 24 ounce bottle of beer 4-6 times a week. … denies drinking wine or hard liquor. …….. does admit to smoking marijuana on occasion but does not use other recreational drugs. NR 601 Week 5 Case Study Discussion.

Patient denies falling. You notice some scrapes on his forearms, and when asked, he tells you that he fell yesterday: “I got pretty drunk out fishin’ with friends and fell off my bike trying to ride home”. He does not use any assistive devices for ambulation or balance.

Significant ROS:

Productive cough with white sputum. Denies hemoptysis.

He answers “No” to the PHQ-2 screening questions.

Family history:

Reports no significant family history

Discussion Part One:

Provide differential diagnoses (DD) with rationale.

Further ROS questions needed to develop DD.

Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.

NR 601 Week 5 Case Study Discussion Part Two (graded)

Physical examination:

Vital Signs:

Height:  5’8”   Weight: 154 pounds BMI: 23.4   BP: 132/76    P: 76

regular    R: 16

HEENT: Normocephalic, symmetric. PERRLA, EOMI, no cataracts noted; poor dentition.

NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. NR 601 Week 5 Case Study Discussion.

LUNGS: Respirations are unlabored, decreased breath sounds and crackles at the bases bilaterally. Prolonged expiratory phase throughout lung fields, inspiratory wheezes and a productive cough of cloudy white sputum.

HEART: RRR with regular without S3, S4, murmurs or rubs.

ABDOMEN: Round, firm abdomen; active bowel sounds;  non-tender.

NEUROLOGIC: Unsteady gait, swaying while standing during periods of agitation. Achilles reflexes are present bilaterally. Strength is equal but decreased in the upper and lower extremities bilaterally.

GENITOURINARY:  Urinary incontinence with strong odor of urine. NO CVA tenderness.

MUSCULOSKELETAL: Mild kyphosis. Heberden’s nodes at the distal interphalangeal joints (DIP) of all fingers, and marked crepitus of the bilateral knees on flexion and extension. Pedal pulses palpable. No edema noted in lower extremities. NR 601 Week 5 Case Study Discussion.

PSYCH: Manic, restless, angry and hyperverbal

SKIN: Right forearm with 3 cm x 5 cm x 0 cm dry, scabbed abrasion. Left forearm with 4 cm x 5 cm x 0 cm dry, scabbed abrasion. NR 601 Week 5 Case Study Discussion.

NR 601 Week 5 Case Study Assignment Self Check Spring 2018

Purpose

The purpose of this case study assignment is to

Analyze provided subjective and objective information to diagnose and develop a management plan for the case study patient.

Apply national diabetes guidelines to case study patient management plan.

Demonstrate mastery of SOAP note writing.

Preparing The Assignment

The assignment is a paper which is to be written in APA format. This includes a title page and reference page. The paper shall not exceed 20 pages. Review the attached patient visit information. The patient has presented for an acute care visit. You are provided with the subjective and objective exam findings. As the provider, you are to diagnose and develop the management plan for this case study patient. Use the categories below to create section headings for your paper. Review the APA manual for paper format instructions.

Introduction: Briefly discuss the purpose of this paper.

Assessment: Review the provided case study information.

Identify the primary, secondary and differential diagnoses for the patient. Use the 601 SOAP note format as a guide to develop your diagnoses. Each diagnosis will include the following information:

ICD 10 code.2.A brief pathophysiology statement which his no longer that

Sentences, paraphrased and includes common signs and symptoms of the diagnosis.

The patient’s pertinent positive and negative findings, including a brief 1-2 sentence statement which links the subjective and objective findings (including lab data and interpretation). NR 601 Week 5 Case Study Discussion.

A rationale statement which summarizes why the diagnosis was chosen.

Do not include quotes, paraphrase all scholarly information and provide an intext citation to your scholarly reference. Use the Reference Guidelines document for information on scholarly references.

NR 601 Week 5 Case Study Discussions Physical Examination​ (Part-1) NEW

Discussion Part One (graded)

C.W. is a tall, thin 78-year-old African American male brought into the office by his son who states that the patient is restless, angry, and has been unable to sleep for the last week. The son indicates that he is very concerned about his father because he lives alone. Also, he is concerned about the “strange” symptoms that his father has presented with recently. NR 601 Week 5 Case Study Discussion.

Background: 

C.W. presents as restless, hyperverbal, obnoxious and angry. He expresses himself by periodic yelling. He is unkempt and smells strongly of urine, alcohol and body odor. ………… has an unsteady gait and sways while standing. As you converse with the son, you determine that C.W. was medically separated from military service due to mental health issues after 2 years of active duty that ended in 1947. He has been married and divorced three times over the years. He typically seeks no acute or preventative medical care. ___ was treated by a psychiatrist previously, but he did not like taking the prescribed medications so he stopped taking them and did not keep any further psychiatric appointments.

PMH:

Patient denies any previous diagnoses. However, when asked why he saw a psychiatrist in the past, he tells you that the psychiatrist diagnosed paranoid schizophrenia, but that he does not have any psychiatric diagnoses or problems. He states: “It was just a way for him to make money off me coming in and seeing him and paying the drug companies for me to take all those meds!” NR 601 Week 5 Case Study Discussion.

Current medications: 

Denies prescription medications, over the counter medication, herbal therapies or vitamins.

Surgeries:

Denies surgeries

Allergies: 
NKA

Vaccination History:

Flu vaccine: never given

Pneumovax: never given

Tetanus: never given

Herpes zoster: never given

Screening History:

Last Colonoscopy was 2012-normal

Last dilated retinal and glaucoma exam was 2013 

Social history and Risk Factors:

Patient admits to smoking cigarettes and cigars. …… estimates that he smokes about 1 pack of cigarettes daily for the last 40 years, and 2 cigars each week for the last 30 years.

He states that he drinks a 24 ounce bottle of beer 4-6 times a week. … denies drinking wine or hard liquor. …….. does admit to smoking marijuana on occasion but does not use other recreational drugs.

Patient denies falling. You notice some scrapes on his forearms, and when asked, he tells you that he fell yesterday: “I got pretty drunk out fishin’ with friends and fell off my bike trying to ride home”. He does not use any assistive devices for ambulation or balance. NR 601 Week 5 Case Study Discussion. NR 601 Week 5 Case Study Discussion.

Significant ROS:

Productive cough with white sputum. Denies hemoptysis.

He answers “No” to the PHQ-2 screening questions.

Family history:

Reports no significant family history

Discussion Part One:

Provide differential diagnoses (DD) with rationale.

Further ROS questions needed to develop DD.

Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.

Introduction

The purpose of this paper is to review the patient’s subjective and objective information from the visit, and analyze the information to formulate an appropriate diagnosis; then develop an evidence based plan of care for the patient, by applying the National Diabetes Guidelines to the care for mature and aging families…………….. I will demonstrate comprehensive knowledge and proficiency on my ability to correctly write a SOAP note.

Assessment

Primary Diagnosis:
 Diabetes (E10.9) Pathophysiology of diabetes type I is insulin dependent, this is the inability of the pancreatic beta cells to produce insulin due to autoimmune destruction; type II, the pancreas does not produce enough insulin needed by the body, or the body is unable to use insulin properly (American Diabetes Association, 2017). Symptoms: fatigue, excessive thirst, hunger, and frequent urination.

Secondary Diagnosis:
 Hyperlipidemia (E78.5) Pathophysiology of hyperlipidemia is the increase in the plasma lipid levels by the over production of TG-rich lipoproteins in the liver (Shattat, 2014). Symptoms: Typically does not have any symptoms.

Hypertension (I15.2) Pathophysiology of hypertension is the increase in the vascular resistance, stiffness, and the vascular system to respond to stimuli (Delacroix, Chokka & Worthley, 2014). Symptoms: Typically have no symptoms………………………., back and joint aches, and overweight.

Left knee arthritis (M19.072) Pathophysiology of osteoarthritis-cartilage loss and the thickening of the subchondral plate, and production of new bone in the joint spaces (Ashkavand, Malekinejad & Vishwanath, 2013). Symptoms: Joint pain, stiffness, swelling, and tenderness. NR 601 Week 5 Case Study Discussion.

Differential Diagnosis: 
Proteinuria (R80.9) Pathophysiology of proteinuria is structural damage to the kidneys, glomerular membrane, and tubulointerstitial tissue from an alteration in of metabolic changes such as hyperglycemia, hyperlipidemia, and hypertension, causing an increase in the urinary albumin (Shen, Fang, Xing & Wang, 2017). Symptoms: Protein in urine, hypertension, and increase need to urinate, fatigue, weight gain from fluid retention, foamy urine, and swelling in the face and extremity.

            I chose each diagnosis based of the CC and labs that were both subjective and objective findings. The patient has an Hgb A1C of 7.7 and glucose in her urine which indicate diabetes, according to the (American Diabetes Association, 2016) an A1C of 6.5 or greater meets the criteria for diabetes, to confirm the patient’s diagnosis she will need to repeat the A1C. She also has symptom of diabetes such as fatigue, excessive thirst, hunger, and frequent urination. Mrs. G blood pressure is 130/82, which is considered stage I hypertension according to the (American College of Cardiology, 2017); systolic pressure 130-139 or diastolic 80-89. Her triglycerides are 232, LDL 143, HDL 37, TC 228; the normal for triglycerides should be between 50-150, LDL should be less than 100, and HDL should be greater than 40, and the TC should be less than 200, this would indicate hyperlipidemia (American Diabetes Association, 2017). The patient is 5’2 and weighs 190 pounds which gives her a BMI of 34.8, a BMI of 30-35 or greater is classified as Obesity (Nuttall, 2015). The patient has protein in her urine which could be an indicator of proteinuria or kidney disease; she also has symptoms of proteinuria which includes protein in urine, hypertension, and increase need to urinate, fatigue, weight gain (Shen, Fang, Xing & Wang, 2017). The patient has a history of arthritis, as well as obesity; some contributing factors to osteoarthritis are obesity, age, women are more at risk, and a sedentary lifestyle (Ashkavand, Malekinejad & Vishwanath, 2013) NR 601 Week 5 Case Study Discussion.

NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System

Week 6: Assessment of the Abdomen and Gastrointestinal System

On your way home from dinner, you start experiencing sharp pains in your abdomen. You ate seafood—could you have food poisoning? What else might be causing your pain? Appendicitis? Should you head to the emergency room, or should you wait and see how you feel in the morning?

Numerous ailments can affect the GI system and the abdomen. Because the organs are so close, it can be difficult to conduct an accurate assessment. Also, pain in another area of the body can affect the GI system. For example, patients with chronic migraines often report nausea.

This week, you will explore how to assess the abdomen and gastrointestinal system.

Learning Objectives – Week 6: Assessment of the Abdomen and Gastrointestinal System

Students will:

Evaluate abnormal abdomen and gastrointestinal findings

Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the abdomen and gastrointestinal system

Photo Credit: Hill Creek Pictures/UpperCut Images/Getty Images

Learning Resources – Week 6: Assessment of the Abdomen and Gastrointestinal 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.

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 4, “Vital Signs and Pain Assessment” (pp. 50-63)This chapter describes the experience of pain and its causes. The authors also describe the process of pain assessment. NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System.

 

Chapter 17, “Abdomen” (pp. 370-415)In this chapter, the authors summarize the anatomy and physiology of the abdomen. The authors also explain how to conduct an assessment on the abdomen.

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 3, “Abdominal Pain” (pp. 11-32)This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.

Chapter 10, “Constipation” (pp. 110-117)The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.

Chapter 12, “Diarrhea” (pp. 133-147)In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.

Chapter 29, “Rectal Pain, Itching, and Bleeding” (pp. 344-356)This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.

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

Chapter 10, “Admitting a Patient to the Hospital” (pp. 217-238)

Note:
 Download this Adult Examination Checklist and Abdomen Physical Exam Summary to use during your practice abdominal 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 abdominal assessment. In 
Mosby’s guide to physical examination
 (7th ed.). St. Louis, MO: Elsevier Mosby.

This Adult Examination Checklist: Guide for Abdominal 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: Abdomen. In 
Mosby’s guide to physical examination
 (7th ed.). St. Louis, MO: Elsevier Mosby.

This Abdomen 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/

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 gastrointestinal radiology.

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 7, and 17 that relate to the assessment of the abdomen and gastrointestinal system. Refer to Week 4 for access instructions on https://evolve.elsevier.com/. NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System.

Optional Resources- Week 6: Assessment of the Abdomen and Gastrointestinal System

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

Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)This chapter explores the health assessment processes for the abdomen, perineum, anus, and rectosigmoid. This chapter also examines the symptoms of many conditions in these areas.

Chapter 10, “The Urinary System” (pp. 528–540)In this chapter, the authors provide an overview of the physiology of the urinary system. The chapter also lists symptoms and conditions of the urinary system. NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System.

NURS 6512 Assesment 1: Assessing the Abdomen

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

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

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.

Abdominal Assessment

SUBJECTIVE:

CC: “My stomach hurts, I have diarrhea and nothing seems to help.”

HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.

PMH: HTN, Diabetes, hx of GI bleed 4 years ago

Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs

Allergies: NKDA

FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD

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

OBJECTIVE:

VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs

Heart: RRR, no murmurs

Lungs: CTA, chest wall symmetrical

Skin: Intact without lesions, no urticaria

Abd: soft, hyperctive bowel sounds, pos pain in the LLQ

Diagnostics: None

NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System

ASSESSMENT:

Left lower quadrant pain

Gastroenteritis

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:

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.

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

What diagnostic tests would 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 current evidence based literature.

By Day 7

This assignment is due.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 6 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 6 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:

Week 6 Assignment

Week 6 Midterm Exam

This exam is a test of your knowledge in preparation for your certification exam. 
No outside resources
 including books, notes, websites, or any other type of resource are to be used to complete this exam. You are expected to 
comply with Walden University’s Code of Conduct
.

This exam will be on topics covered in weeks 1, 2, 3, 4, 5, and 6. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of two hours for completion. When time is up, your exam will automatically submit.

Assignment 2 (Optional) Practice Assessment: Abdominal Examination

The causes of abdominal pain can be extremely varied due to the sheer number of structures, organs, and functions within the abdomen. If abdominal pain is caused by a life-threatening condition, then swift and accurate assessment is essential.

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

Download and review Adult Examination Checklist: Guide for Abdominal Assessment provided in this week’s Learning Resources.

To perform the examination, ensure that you have a stethoscope, a centimeter ruler, measuring tape, and marking pens to mark the areas of measurement for consistency in measuring. NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System.

To complete:

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

Rubric Detail

 

Select 
Grid View
 or 
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 to change the rubric’s layout.

Content

Name: NURS_6512_Week_6_Assignment1_Rubric

Excellent

Good

Fair

Poor

Quality of Work Submitted:

The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.

Points Range:
 27 
(27%)
 – 30 
(30%)

Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.

Points Range:
 24 
(24%)
 – 26 
(26%)

Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.

Points Range:
 21 
(21%)
 – 23 
(23%)

Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.

Points Range:
 0 
(0%)
– 20 
(20%)

Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.

Assimilation and Synthesis of Ideas:

The extent to which the work reflects the student’s ability to:Understand and interpret the assignment’s key concepts.

Points Range:
 27 
(27%)
 – 30 
(30%)

Demonstrates the ability to critically appraise and intellectually explore key concepts.

Points Range:
 24 
(24%)
 – 26 
(26%)

Demonstrates a clear understanding of key concepts.

Points Range:
 21 
(21%)
 – 23 
(23%)

Shows some degree of understanding of key concepts.

Points Range:
 0 
(0%)
– 20 
(20%)

Shows a lack of understanding of key concepts, deviates from topics.

Assimilation and Synthesis of Ideas:

The extent to which the work reflects the student’s ability to:Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.

NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System

Points Range:
 18 
(18%)
 – 20 
(20%)

Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to support point of view.

Points Range:
 16 
(16%)
 – 17 
(17%)

Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view.

Points Range:
 14 
(14%)
 – 15 
(15%)

Minimally includes and integrates specific information from 2-3 resources to support major points and point of view.

Points Range:
 0 
(0%)
– 13 
(13%)

Includes and integrates specific information from 0 to 1 resource to support major points and point of view.

Written Expression and FormattingParagraph/Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.

Points Range:
 9 
(9%)
 – 10 
(10%)

Paragraphs/Sentences follow writing standards for structure, flow, continuity and clarity

Points Range:
 8 
(8%)
– 8 
(8%)

Paragraphs/sentences follow writing standards for structure, flow, continuity and clarity 80% of the time.

Points Range:
 7 
(7%)
– 7 
(7%)

Paragraphs/sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time.

Points Range:
 0 
(0%)
– 6 
(6%)

Paragraphs/sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time. Written Expression and FormattingEnglish writing standards: Correct grammar, mechanics, and proper punctuation. Points Range:  5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. Points Range:  3  (3%) – 4  (4%) Contains a few (1-2) grammar, spelling, and punctuation errors. Points Range:  2  (2%) – 2  (2%) Contains several (3-4) grammar, spelling, and punctuation errors. Points Range:  0  (0%) – 1  (1%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and FormattingThe assignment follows parenthetical/in-text citations, and at least 3 evidenced based references are listed. Points Range:  5  (5%)  – 5  (5%) Contains parenthetical/in-text citations and at least 3 evidenced based references are listed. Points Range:  3  (3%) – 4  (4%) Contains parenthetical/in-text citations and at least 2 evidenced based references are listed Points Range:  2  (2%) – 2  (2%) Contains parenthetical/in-text citations and at least 1 evidenced based reference is listed Points Range:  0  (0%) – 1  (1%) Contains no parenthetical/in-text citations and 0 evidenced based references listed. Total Points: 100 Name: NURS_6512_Week_6_Assignment1_Rubric NURS 6512 Week 6: Assessment of the Abdomen and Gastrointestinal System

Nursing population’s cultural diversity Essay

Question description

Nursing population’s cultural diversity: For this written assessment we will focus on generational diversity in the nursing population. Review table 12.2 on p. 379 of your textbook and address the following:

Define and describe the four generations (veterans, baby boomers, generation x, and millennials) – name, timeframe, and a description of that group’s characteristics.

Choose the group to which you belong. Explain how you think that you fit with this assessment of that generation. (I am apart of the millennial group, born 1990)

Select any other group to which you do not belong. Explain how those from your group can learn from that group, and explain how that group could learn from yours. Nursing population’s cultural diversity Essay.

Nursing population’s cultural diversity requirement

B
ook: Transcultural concepts in nursing care, Andrews & Boyle, 7th ed
.

Minimum 600words, APA format, must have introduction and conclusion. Minimum of four (4) total references: two (2) references from required course materials and two (2) peer-reviewed references. All references must be no older than five years (unless making a specific point using a seminal piece of information) Nursing population’s cultural diversity Essay.

Peer-reviewed references include references from professional data bases such as PubMed or CINHAL applicable to population and practice area, along with evidence based clinical practice guidelines. Examples of unacceptable references are Wikipedia, UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, & secondary clinical databases. Nursing population’s cultural diversity Essay.

Cervical cancer STI virus essay

Cervical cancer STI virus: Fifteen-year-old Dolores was embarrassed to talk with her mother about the pain she felt in her “private parts,” but she was worried she might have gotten a disease, despite Nick’s assurance that she was his “first.” Her mother insisted that Dolores see a doctor, who discovered cervical lesions caused by a virus associated with cancer.

What sexually transmitted virus is involved?

How should the physician treat the lesions?

How could Dolores have protected herself?

Cervical cancer STI virus essay

Human papiliomavirus (HPV) is involved in the infection. This virus causes benign papiliomas and premalignant lesions that will drive cancers of cervix, ulva, vagina, penis, oropharynx and anus. They are typically transmitted through sexual contact. Cervical cancer STI virus essay.

Advanced Physiology and Pathophysiology – Disorders of Fluid and Electrolyte Balance Case Study

Case Study 3:  Disorders of Fluid and Electrolyte Balance

Amanda is an 18-year-old with anorexia nervosa. She was recently admitted to an eating disorders clinic with a BMI of 13.9, and although she was a voluntary patient, she was reluctant about the treatment. She was convinced she was overweight because her clothes felt tight on her. She complained that even her hands and feet “were fat.” One of her nurses explained that a protein in her blood was low. The nurse further explained that, as difficult as it may be to believe, eating a normal healthy diet would make the “fat hands and feet” go away. Advanced Physiology and Pathophysiology – Disorders of Fluid and Electrolyte Balance Case Study.

What protein do you suspect the nurse was referring to? How would a deficiency in this protein contribute to edema?

What is the difference between the physiology of pitting and nonpitting edema?

Because of her weakened condition, Amanda was moved around the ward in a wheelchair when she was not on bed rest. How does this affect her edematous tissues? Advanced Physiology and Pathophysiology – Disorders of Fluid and Electrolyte Balance Case Study.

Natonstate Insurance and RR Communication Case Studies

Below are two case study due by Saturday. I need 2 copies of each case study. It should be done in APA format. I have attached the sample APA format document.

RR Communication Case Study

Read the RR Communications Case Study on pages 156-159 in the textbook. Answer Discussion Questions 1-3 at the end of the Case Study. Your responses must be complete, detailed and in APA format. See the sample assignment for expected format and length. The grading rubric is included below. 4-5 pages

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Textbook:

Read the Nationstate Case Study on pages 160-164 in the textbook. Answer Discussion Questions 1-2 at the end of the Case Study. Your responses must be complete, detailed and in APA format. See the sample assignment for expected format and length. The grading rubric is included below. 4-5 pages

Textbook: Natonstate Insurance and RR Communication Case Studies

MN553 Practice Quiz Question

Question 1 1 / 1 point

Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:

Question options:

A need to monitor drugs metabolized by 2D6 for toxicity

Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors

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Decreased conversion of codeine to morphine by CYP 2D6

The need for lowered dosages of drugs, such as beta blockers

Question 2 1 / 1 point

Rifampin is a nonspecific CYP450 inducer that may:

Question options:

Lead to toxic levels of rifampin and must be monitored closely

Cause toxic levels of drugs, such as oral contraceptives, when coadministered

Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure

Cause nonspecific changes in drug metabolism

Question 3 1 / 1 point

Inhibition of P-glycoprotein by a drug such as quinidine may lead to:

Question options:

Decreased therapeutic levels of quinidine

Increased therapeutic levels of quinidine

Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination

Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination

MN553 Practice Quiz Question 4 1 / 1 point

Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

Question options:

Toxic levels of warfarin building up

Decreased response to warfarin

Increased risk for significant drug interactions with warfarin

Less risk of drug interactions with warfarin

Question 5 1 / 1 point

Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:

Question options:

Erythromycin

Digoxin

Cetuximab

Rifampin

Question 6 1 / 1 point

Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to:

Question options:

Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele

Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele

Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 Allele

Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine

Question 7 1 / 1 point

A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:

Question options:

Decreased effectiveness of irinotecan in the treatment of cancer

Increased adverse drug reactions, such as neutropenia

Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38

Increased concerns for irinotecan being carcinogenic

Question 8 1 / 1 point

A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products.

Question options:

10

5

38

70

Question 9 1 / 1 point

A potential harmful effect on patients who take some herbal medication is:

Question options:

Constipation

Lead poisoning

Diarrhea

Life-threatening rash

MN553 Practice Quiz Question 10 1 / 1 point

A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains:

Question options:

Coumadin, which may lead to bleeding problems

Coumarin, which can cause liver and kidney damage

Cinnamic aldehyde, which is toxic to the kidney

Cinnamate eugenol, which is toxic to the liver

Question 11 1 / 1 point

Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing and treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe:

Question options:

Herbs which are yang in nature

Herbs that are yin in nature

Ginger

Golden seal

Question 12 1 / 1 point

According to traditional Chinese medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient’s illness will:

Question options:

Get worse

Get better

Not be adequately treated

Need additional herbs to treat the yang

Question 13 1 / 1 point

In Ayurvedic medicine, treatment is based on the patient’s dominant dosha, which is referred to as the person’s:

Question options:

Vata

Pitta

Kapha

Prakriti

Question 14 1 / 1 point

When melatonin is used to induce sleep, the recommendation is that the patient:

Question options:

Take 10 mg 30 minutes before bed nightly

Take 1 to 5 mg 30 minutes before bed nightly

Not take melatonin more than three nights a week

Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep

Question 15 1 / 1 point

In the United States, over-the-counter drugs are regulated by:

Question options:

No one. There is no oversight for over-the-counter medications.

The U.S. Food and Drug Administration Center for Drug Evaluation and Research

The U.S. Drug Enforcement Administration

MedWatch

Question 16 1 / 1 point

As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to:

Question options:

Get a new patent for the over-the-counter form of the drug

Lower the costs because most prescription benefit plans do not cover generics

Market the drug to a whole new population, as they are able to market to patients instead of just providers

Continue to make large profits from their blockbuster brand-name drug

MN553 Practice Quiz Question 17 1 / 1 point

The ailment that generates the greatest over-the-counter annual drug sales is:

Question options:

Constipation

Cough and colds

Heartburn

Acute and chronic pain

Question 18 1 / 1 point

Common over-the-counter pain relievers such as acetaminophen or ibuprofen:

Question options:

Are always safer for the patient than prescription pain medication

Are harmful if taken in higher than recommended amounts

Have minimal interaction with prescription medications

Should never be given to children unless recommended by their provider

Question 19 1 / 1 point

When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of:

Question options:

His appropriately only telling you about his regularly prescribed medications

His hiding information regarding his inappropriate use of aspirin from you

A common misconception that intermittently taken over-the counter medications are not an important part of his drug history

A common misuse of over-the-counter aspirin

Question 20 1 / 1 point

Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must:

Question options:

Be safe and labeled for appropriate use

Have a low potential for abuse or misuse

Be taken for a condition the patient can reliably self-diagnose

All of the above

MN553 Practice Quiz

NR 509 APEA EXAM – HEENT

Question 1:
 The function of the auditory ossicles is to:

Question 2:
 A 35-year-old patient complains of vertigo accompanied by nausea and vomiting. Examination reveals bilateral diplopia and an unsteady gait. These symptoms could be suggestive of:

3. A 60-year-old was concerned about a yellowish colored lesion above her right eyelid. Findings revealed a slightly raised yellowish, well circumscribed plaque along the nasal area of her right eyelid. This finding is most consistent with:

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4. Assessment of a patient’s visual acuity resulted in 20/200 using the Snellen eye chart. This means that:

APEA HEENT

5. Findings following assessment of a person’s left eye gaze include impaired movements when attempting to look upward, downward, or inward. This condition is most consistent with: a conjugate gaze.

6. Findings following assessment of a person’s eye gaze include both eyes moving in the same direction simultaneously. This condition is most consistent with: a conjugate gaze.

7. A patient was diagnosed as being farsighted. The term for this condition is:

8.  buildup of excess fluid around the periphery of the eye orbits is known as:

9. hat connects the middle ear to the nasopharynx? NR 509 APEA EXAM – HEENT.

10. The fleshly projection of the earlobe is known as the:

11.Then examining the pupils, the left pupil is noted to be fixed and dilated to light and near accommodation. This condition may be suggestive of:

12. A deposit of uric acid crystals appearing as hard nodules on the helix or antihelix is termed:

13. n the outer ear, anterior and parallel to the helix, is a curved prominence known as the:

14. On examination of the pupils, both are round but the right pupil appears larger than the left and reacts much slower to light. This condition may be indicative of:

15. A six-year-old complains that something is in her left eye. There is a red raised area of the left lid. There is redness and tenderness of the eye and tearing. These findings are consistent with:

16. Ophthalmoscopic examination of the retina reveals AV tapering. This appears as if the: vein “winds” down on either side of the artery.

17.  A patient presents with complaints of burning, itching, tearing, and some pain in the eye. Findings reveal red, scaly, greasy flakes and thickened, crusted lid margins. This would be suggestive of:

18. Ophthalmoscopic examination of the fundus reveals small, rounded, slightly irregular red spots embedded in the retina. These findings are consistent with: NR 509 APEA EXAM – HEENT.

19. Redness, bleeding, pain, and swelling of the gums is most likely nr 509 apea exam

20. Ophthalmoscopic examination of the retina reveals a normal arteriovenous crossing. This appears as if the:

21. Otosclerosis is an example of a(n):

22.  Which of the following findings in a preschooler would indicate the need for further evaluation?

23. A 50- year-old patient complains of being unable to read the hymnal at church. This describes:

24. The gradual loss of vision with a change in color and size of the optic disc is referred to as:

25. In order to examine the tongue, ask the patient to stick out his tongue and with the examiner’s right hand nr 509 apea exam

26. A 30-year-old patient presents with complaints of seeing double in the right eye. Examination reveals diplopia in the right eye when the left eye is …… This may be suggestive of a:

27. One cause of nasal septum perforation may be:

28. A 30-year-old patient presents with a moderate “aching” in his right eye. Findings reveal a small and irregular shaped right pupil.

29. Sudden bilateral and painless visual loss is rare but can be associated with all the following except:

30. On ophthalmoscopic examination, optic atrophy appears: NR 509 APEA EXAM – HEENT.

31. Ophthalmoscopic examination of the retina reveals AV banking. This appears as if the: vein tapes down on either side of the artery.

32. Causes of sensorineural hearing loss include all of the following except nr 509 apea exam

33. What visual acuity constitutes legal blindness?

34. An example of a cause of conductive hearing loss in children would be:

35. Miosis is a term used to describe:

36.  If a patient complains of seeing flashing lights across the field of vision, this could be: NR 509 APEA EXAM – HEENT

Toulmin Outline: Are Children Overmedicated in ADHD and ADD:

Using the TOULMIN OUTLINE, write a paper that discusses your position on whether or not children are over-medicated in regards to ADD and ADHD.

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Toulmin Outline: Are Children Overmedicated in ADHD and ADD

NB: This is a sample introduction

There exists increased public concern, especially among health research specialists that many American children receive early and often unnecessary exposure to ADD and ADHD medication. The diagnosis discourses of ADD and ADHD are intrinsically problematic, simply because the diagnosis seeks such symptoms as impulsivity, hyperactivity and distractibility, traits that, in children, tend to be consistent with normal developmental behavior. However, upon diagnosis, the implication is always that the child is characteristically impulsive, hyperactive or distractible. That this approach to diagnosing ADD and ADHD in children is flawed relates to the ocean of misdiagnosis reported across the globe, hence the need to determine where to draw the line between medical disorder and developmentally normal behavior. Toulmin Outline: Are Children Overmedicated in ADHD and ADD.

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A study by Visser (2013) established that in 2011, about 11 percent of children aged between 4 and 17 years had received positive diagnosis of ADHD, primarily through parental reporting, most of which were on related ADHD drugs. The study also cites earlier findings that indicate that about 7.5 percent of U.S. children below age 17 are on medication related to emotional or behavioral difficulties with a another study contending that the number of children on psychostimulants has increased five-fold between the periods 1988-1994 and 2007-2010. That these diagnoses and the subsequent administration of ADD and ADHDF related drugs proceed from parental diagnosis as opposed to physician diagnosis is particularly of greater concern. Toulmin Outline: Are Children Overmedicated in ADHD and ADD.

NR 509 APEA EXAM – WOMEN’S HEALTH

Question 1:
 When palpating the cervix during the bimanual exam, cervical motion tenderness (chandelier sign) is noted. This tenderness could be suggestive of:

Question 2:
 In a female diagnosed with a first-degree uterine prolapse, the cervix:

3: Daughters of women who took Diethylstilbestrol (DES) during pregnancy are at a high risk for developing all of the following abnormalities except:

4: A female patient presents with a profuse, yellowish, green vaginal discharge that is malodorous. This vaginal discharge is most consistent with:

5: The most common causes of sexual problems in females are …..

6: Chronic pelvic pain refers to pain that does not respond to therapy and:

7: In female patients with dyspareunia, superficial pain is most likely related to all of the following except: NR 509 APEA EXAM – WOMEN’S HEALTH.

8: If urethritis or inflammation of the paraurethral glands is suspected in a female patient, the index finger should be inserted into the vagina and:

9: Upon examination of the vagina, a swollen red ring is noted around the urethral opening. This finding is most consistent with a:

10: When performing a bimanual vaginal exam, a solid, nodular-like lesion is palpated over the right ovary. This finding is most consistent with:

11: Indications for performing a rectovaginal exam include all of the following except to:

12: Examination of a female patient’s right breast reveals a retraction of the nipple and areola. This finding is consistent with: NR 509 APEA EXAM – WOMEN’S HEALTH.

13: To assess pelvic floor muscle strength during the bimanual vaginal exam, have the patient squeeze around the inserted fingers for as long as possible. To consider full strength, snug compression should last for:

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14: Upon examination of the vagina, a tense, hot, very tender abscess with labial swelling is noted. This finding is most consistent with a:

15: A female patient has a history of a retroverted uterus. This condition refers to:

16: Upon examination of the vagina, the entire anterior vaginal wall, together with the bladder and urethra create a bulge. This condition is most consistent with a:

17: Urethritis in a female patient may arise from all of the following organisms except:

18: To palpate the uterus during a bimanual exam, the examiner would lubricate the index and middle fingers of one hand and insert them into the vagina. The other hand would be placed on the abdomen: NR 509 APEA EXAM – WOMEN’S HEALTH.

19: When do the ovaries become non-palpable after menopause?

20: When performing a rectal exam on a female, a hard nodular rectal “shelf” is palpable at the tip of the examiner’s finger. This finding is suggestive of:

21: A twenty-year-old female complains of a milky discharge bilaterally from her breasts. This suggests:

22: A woman complains of infrequent menses with intervals greater than 35 days. This condition is …..

23: The most common cause of acute pelvic pain in women is:

24: When performing a vaginal exam with a speculum, the use of the upper blade as a retractor could expose a:

25: When preparing to perform a pelvic exam in an older female, vaginal atrophy is noted. Due to this finding, the speculum:

26: Upon examination of the cervix, a yellow drainage is visible around the cervical os. This finding is most likely suggestive of: NR 509 APEA EXAM – WOMEN’S HEALTH.

27: When examining the cervix, a bright, red, soft and fragile lesion is noted on the cervical surface. This finding is consistent with:

28: During examination of the vagina, a bulge in the upper two-thirds of the anterior vaginal wall is noted. This symptom is most consistent with a:

29: The most common type of hernia in women is the:

30: A female patient presents with a gray, thin, malodorous (fishy) vaginal discharge. These symptoms are most consistent with:

31: When performing a bimanual vaginal exam, a smooth and rather compressible non-tender lesion is palpated over the right ovary. This finding is most consistent with:

32: When performing the bimanual vaginal exam, a nodule on the anterior uterine surface could suggest a (an):

33: Cessation of the menses for 12 months is ….

34: A woman complains of experiencing uterine bleeding between expected menstrual cycles. This condition is …..

35: A 45-year old female presents to the nurse practitioner with complaints of postcoital bleeding (greater than spotting) unrelated to the menstrual cycle. What is the most likely cause?

36: When performing the bimanual vaginal exam, uterine enlargement is …… This enlargement could suggest: NR 509 APEA EXAM – WOMEN’S HEALTH.

37: In which of the following situations would it be difficult for the examiner to palpate an ovary during the bimanual vaginal exam?

38: Causes of post menopausal bleeding typically include all of the following except:

39: A 35-year-old female presents with complaints of swelling of her right breast. Findings reveal edema of the lower portion of her right breast. The skin appears thickened with enlarged pores. This condition is consistent with:

40: The shiny, pink area located around the cervical os is ….as nr 509 apea exam

41: During a speculum exam of the cervix the speculum is maintain in an open position by:

42: A female patient presents with a white and curd-like thin vaginal discharge. This discharge is most consistent with:

Question 43:
 Upon examination of the vagina, a bulge is …..in the lower posterior wall of the vagina. This finding is most consistent with a:

Question 44:
 Upon examination of the cervix, an irregular cauliflower-like growth was ….around the cervical os. This finding is most suggestive of:

45: Upon examination of the vagina, a small, red, benign tumor is …..at the posterior part of the urethral meatus. This finding is most consistent with a:

46: To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labia majora and:

47: An ulcerated vulvar lesion in an elderly woman may indicate nr 509 apea exam

48: Pelvic floor muscle weakness may be due to all of the following except:

49: In a female diagnosed with a third-degree uterine prolapse, the cervix:

50: A woman complains of abnormally heavy and prolonged menstrual periods that occur at regular intervals. This condition is most likely:

51: In a female diagnosed with a second-degree uterine prolapse, the cervix:

52: A woman complains of experiencing frequent menses with intervals of fewer than 21 days. This condition is …..

53: If performed correctly and in a timely fashion, which one of the following is most definitive for the diagnosis of breast cancer? NR 509 APEA EXAM – WOMEN’S HEALTH.

54: Retraction of the nipple and areola suggest:

55: The vaginal mucosa lies in transverse folds ……

56: The most important risk factor for cervical cancer is nr 509 apea exam

57: When performing a bimanual exam of the vagina, the examiner should lubricate the index and middle fingers of a gloved hand. From a standing position, the fingers should be ….into the vagina while exerting pressure primarily:

58: Fixed flattening of the nipple suggests:

59: Chronic pelvic pain may be secondary to all of the above except:

60: When discussing the female anatomy, the introitus is also ….as the nr 509 apea exam

61: When performing a breast exam, a mobile mass becomes fixed when the arm relaxes. This suggests that the mass is:

62: To palpate the right ovary when performing the bimanual vaginal exam, the abdominal hand should be on the right lower quadrant and the pelvic hand needs to be:

63: When performing an examination of the external genitalia of a female patient, a small, firm, round cystic nodule in the labia is …… This lesion is most consistent with:

64: Primary dysmenorrhea results from:

65: The deep red area located around the cervical os is ….as nr 509 apea exam

66: When examining the cervix, a translucent nodule is …..on the cervical surface. This finding is consistent with:

67: To palpate the left ovary when performing the bimanual vaginal exam, the abdominal hand should be on the left lower quadrant and the pelvic hand needs to be:

68: When performing a vaginal exam with a speculum, the use of the lower blade as a retractor during bearing down could expose an anterior wall defect such as a: NR 509 APEA EXAM – WOMEN’S HEALTH