Tag: Clinical-Nursing

Subjective Data Collection: 40 of 43 (93.0%)

Hover To Reveal…

Hover over the 
Patient Data 
items below to reveal important information, including 
Pro Tips
 and 
Example Questions
.

Found:

 Indicates an item that you found.

Available:

 Indicates an item that is available to be found.

Category

Scored Items

Experts selected these topics as essential components of a strong, thorough interview with this patient. Sick Visit: Management of Endocrine Conditions Shadow health Subjective Data Collection

Patient Data

Not Scored

A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

Chief Complaint

GET SHADOW HEALTH HELP HERE

Finding:

Asked about chief complaint

Finding:

Reports hair loss

(Found)

Pro Tip: Asking your patient in open terms about the reason for their visit allows them to explain their concerns in their own words, providing a foundation for your interview.

Example Question:

What brings you in today?

Finding:

Reports fatigue

(Found)

Pro Tip: Asking your patient in open terms about the reason for their visit allows them to explain their concerns in their own words, providing a foundation for your interview.

Example Question:

What brings you in today?

Orientation

Finding:

Established orientation

Finding:

Oriented to person

(Found)

Pro Tip: Determining a patient’s orientation to the time, place, situation, and their own person allows you to assess their cognitive function, especially when it may be affected by a patient’s health condition.

Example Question:

Can you tell me your name?

Finding:

Oriented to time

(Available)

Pro Tip: Determining a patient’s orientation to the time, place, situation, and their own person allows you to assess their cognitive function, especially when it may be affected by a patient’s health condition.

Example Question:

Can you tell me today’s date?

Finding:

Oriented to place

(Available)

Pro Tip: Determining a patient’s orientation to the time, place, situation, and their own person allows you to assess their cognitive function, especially when it may be affected by a patient’s health condition. Sick Visit: Management of Endocrine Conditions Shadow health Subjective Data Collection

Example Question:

Can you tell me where you are right now?

Finding:

Oriented to situation

(Found)

Pro Tip: Determining a patient’s orientation to the time, place, situation, and their own person allows you to assess their cognitive function, especially when it may be affected by a patient’s health condition.

Example Question:

Do you know why you are here today?

History of Present Illness

Finding:

Asked about onset of fatigue

Finding:

Reports fatigue began 1 month ago

(Found)

Pro Tip: If a patient reveals a medical condition or symptoms they have, it is important to ask a wide variety of follow-up questions about the history of the present illness. This can help providers better understand the nature of the disorder, especially through questions about timing, severity, and types of symptoms.

Example Question:

When did your fatigue start?

Finding:

Asked about timing of fatigue

Finding:

Reports fatigue lasts all day

(Found)

Pro Tip: If a patient reveals a medical condition or symptoms they have, it is important to ask a wide variety of follow-up questions about the history of the present illness. This can help providers better understand the nature of the disorder, especially through questions about timing, severity, and types of symptoms.

Example Question:

How often do you feel fatigued?

Finding:

Asked about aggravating factors for fatigue

Finding:

Denies aggravating factors for fatigue

(Found)

Pro Tip: If a patient reveals a medical condition or symptoms they have, it is important to ask a wide variety of follow-up questions about the history of the present illness. This can help providers better understand the nature of the disorder, especially through questions about timing, severity, and types of symptoms.

Example Question:

Does anything make your fatigue worse?

Finding:

Asked about relieving factors for fatigue

Finding:

Denies relieving factors for fatigue

(Found)

Pro Tip: If a patient reveals a medical condition or symptoms they have, it is important to ask a wide variety of follow-up questions about the history of the present illness. This can help providers better understand the nature of the disorder, especially through questions about timing, severity, and types of symptoms.

Example Question:

Does anything make you less fatigued?

Finding:

Asked about activities of daily living

Finding:

Denies difficulty performing activities of daily living

(Found)

Pro Tip: If a patient reveals a medical condition or symptoms they have, it is important to ask a wide variety of follow-up questions about the history of the present illness. This can help providers better understand the nature of the disorder, especially through questions about timing, severity, and types of symptoms.

Example Question:

Can you perform your activities of daily living?

Finding:

Asked about onset of hair loss

Finding:

Reports hair loss began 3 weeks ago

(Found)

Pro Tip: If a patient reveals a medical condition or symptoms they have, it is important to ask a wide variety of follow-up questions about the history of the present illness. This can help providers better understand the nature of the disorder, especially through questions about timing, severity, and types of symptoms.

Example Question:

When did your hair loss begin?

Past Medical History

Finding:

Asked about existing health conditions

Finding:

Reports diagnosis of hypothyroidism

(Found)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

Do you have any existing health conditions?

Finding:

Reports diagnosis of osteopenia

(Found)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

Do you have any existing health conditions? Sick Visit: Management of Endocrine Conditions Shadow health Subjective Data Collection

Finding:

Asked about onset of existing conditions

Finding:

Reports being diagnosed with hypothyroidism 15 years ago

(Found)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

When were you diagnosed with hypothyroidism?

Finding:

Reports being diagnosed with osteopenia 4 years ago

(Found)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

When were you diagnosed with osteopenia?

Finding:

Asked about hypothyroidism symptoms

Finding:

Denies any known symptoms of hypothyroidism

(Found)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

Does your hypothyroidism cause any symptoms?

Finding:

Asked about osteopenia symptoms

Finding:

Denies any known symptoms of osteopenia

(Available)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment Sick Visit: Management of Endocrine Conditions Shadow health Subjective Data Collection.

Example Question:

Does your osteopenia cause any symptoms?

Finding:

Asked about allergies

Finding:

Denies food allergies

(Found)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

Do you have any food allergies?

Finding:

Denies medication allergies

(Found)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

Do you have any medication allergies?

Finding:

Denies latex allergy

(Available)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

Do you have a latex allergy?

Finding:

Denies environmental allergies

(Found)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

Do you have any environmental allergies?

Finding:

Asked about previous surgeries

Finding:

Denies previous surgeries

(Found)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

Have you ever had surgery?

Finding:

Asked about previous hospitalizations

Finding:

Reports hospitalizations for childbirth

(Found)

Pro Tip: A patient’s past medical history includes their health conditions, what preventative and maintenance treatments they have received, and any previous medical interventions they have received. Asking about a patient’s medical history helps you contextualize their current health for proper assessment.

Example Question:

Have you ever been hospitalized?

Home Medications

Finding:

Asked about vitamins and supplements

Sick Visit: Management of Endocrine Conditions Shadow health Subjective Data Collection

Finding:

Reports taking a supplement for

Maureen Hopkins Shadow health Treatment Plan: 23 of 23 (100.00%)

Problem Selection

7 out of 7

Diagnosis

Learner Selection

Model Documentation

 Diagnosis: 
xxx

Evidences:

 
Change in prescription

xxx

 
xx

 
xx

 
Hair loss

 
Report of xx

Learner Rationale:

Given the signs and symptoms presented by the patient, xxx is the most appropriate diagnosis

Score: 
7 
out of
 7

 Diagnosis: 
xxx

Evidences:

Change in prescription

xx

xxx

xx

Hair loss

Report of xx

Model Rationale:

xx is the most appropriate diagnosis for Mrs. Hopkins given the evidence available. Mrs. Hopkins displays xx, and reports xx, all of which can indicate an exacerbation of xx, with which Mrs. Hopkins has already been diagnosed Maureen Hopkins Shadow health Treatment Plan. Her elevated xx test results also support this diagnosis. This exacerbation in symptoms are likely a result of the pharmacy changing Mrs. Hopkins’s medication from xx, which for some patients can result in medication inefficacy and uncontrolled symptoms.

GET SHADOW HEALTH HELP HERE

Plan of Care

7 out of 7

Review your answers for the Plan of Care activity. You must select “Yes” or “No” for each of the seven care actions. You will receive one point for determining the correct answer for each care action.

Learner Selection

Model Documentation

Pharmacological Intervention

Selected:
xx

Learner Rationale:

xx condition for the patient will require medications to manage the symptoms.

Score: 
1 
out of
 1

Recommended:
xx

The xx issues Mrs. Hopkins is experiencing are related to her medication. She will require a prescription for the appropriate medication to address her symptoms. You will conduct a medication selection in the next activity.

Medication Selection

9 out of 9

This activity represents your ability to synthesize subjective data, objective data, guidelines, drug interactions, and contraindications to select the most effective medications(s) for the patient’s problems. Your points are based on the selection of correct medication(s) for the patient’s indication(s), with some points being removed based on the number of attempted tries.

Learner Selection

Model Documentation

Target:

Hypothyroidism

Selected Medication:

 
xx

Score: 
9 
out of
 9

xx, with the prescription instructions of xx micrograms, xx, is the most appropriate medication selection for Mrs. Hopkins. Mrs. Hopkins had previous success in

Maureen Hopkins Shadow health Treatment Plan

Transcript

Hello.  I am xx. I will interview and examine you

Greet

06/13/23 11:09 PM EDT

Hello there.

What brings you to he clinic today?

Question

06/13/23 11:22 PM EDT

I came in because I’ve been really tired lately. And I’ve had some hair loss. Neither of which are really normal for me. Maureen Hopkins Sick Visit: Management of Endocrine Conditions Shadow health Transcript

am sorry to hear this

Empathize

06/13/23 11:22 PM EDT

Thank you.

when did your start feeling tired?

Question

06/13/23 11:23 PM EDT

I started feeling this tired about a month ago.

In which parts have you lost your hair?

Question

06/13/23 11:24 PM EDT

Yeah, my hair has been falling out and thinning recently.

Does resting make you feel better for fatigue?

Question

06/13/23 11:26 PM EDT

Nothing really makes it better. It feels like it lasts all day.

I am sorry to hear that.

Question

06/13/23 11:26 PM EDT

My hearing’s good. [AUDIO COMING SOON]

Are you taking any medication to help with the hair falling out? (Clarified to Are you on any prescription medication?.)

Question

06/13/23 11:27 PM EDT

I am prescribed medication for my hypothyroidism. I take a supplement for my osteopenia, and a multivitamin, but those are over-the-counter. (Clarified to if I take any prescription medications.)

What remedies are you using to help with the hair fall out?

GET SHADOW HEALTH HELP HERE

Question

06/13/23 11:28 PM EDT

Not every day, but more than one day a week. I’ll notice it if I’m brushing my hair, or washing it, or sometimes even just running my fingers through it. [AUDIO COMING SOON]

How is the distribution of the hair fall out? (Clarified to When do you notice your hair falling out?.)

Question

06/13/23 11:30 PM EDT

Not every day, but more than one day a week. I’ll notice it if I’m brushing my hair, or washing it, or sometimes even just running my fingers through it. [AUDIO COMING SOON] (Clarified to when I notice hair loss.)

After which activities do you feel fatigued? (No matching questions found.)

Question

06/13/23 11:33 PM EDT

What aggravates your fatigue

Question

06/13/23 11:33 PM EDT

I don’t think anything makes it worse — it’s more just a steady tiredness that lasts all day.

Does this make it difficult to perform your daily tasks? (No matching questions found.)

Question

06/13/23 11:35 PM EDT

How has these affected your daily activities? (Clarified to How has your fatigue made it difficult to do things?.)

Question

06/13/23 11:35 PM EDT

It hasn’t — I can still perform my daily activities. (Clarified to how my fatigue has made it difficult to do activities.) Maureen Hopkins Sick Visit: Management of Endocrine Conditions Shadow health Transcript

that’s great

Empathize

06/13/23 11:36 PM EDT

Thank you, dear.

What is your name?

Question

06/13/23 11:37 PM EDT

My name is Maureen Hopkins.

And have you noticed any changes with your skin?

Question

06/13/23 11:39 PM EDT

I’ve had dry skin . . . on my hands, arms, elbows.

Are there any other over-the-counter medications that you are using?

Question

06/13/23 11:41 PM EDT

I take a multivitamin and the calcium and vitamin D supplement — those are over-the-counter.

Do you have any other health issue?

Question

06/13/23 11:42 PM EDT

Yes, I have osteopenia and hypothyroidism.

What do you manage your hypothyroidism?

Question

06/13/23 11:43 PM EDT

It’s called Synthroid.

When did you start taking the medication?

Question

06/13/23 11:44 PM EDT

I’ve taken Synthroid since shortly after being diagnosed with hypothyroidism, around 15 years ago. [AUDIO COMING SOON]

And what dosage of Synthroid do you take? (Clarified to What dose of Synthroid are you taking?.)

Question

06/13/23 11:45 PM EDT

It’s 125 micrograms, if I recall correctly. (Clarified to what dose the Synthroid is.)

And what do you use for your osteopenia? (No matching questions found.)

Question

06/13/23 11:45 PM EDT

Have you been taking your medications as per the prescription? Maureen Hopkins Sick Visit: Management of Endocrine Conditions Shadow health Transcript

Question

06/13/23 11:48 PM EDT

I always take my medications when I should. I use a pillbox, too, which helps.

When do you take the Synthroid medication? (Clarified to When do you take the Synthroid?.)

Question

06/13/23 11:49 PM EDT

I take the Synthroid in the morning every day. (Clarified to when I take the Synthroid.)

Is your hypothyroidism under control? (No matching questions found.)

Question

06/13/23 11:49 PM EDT

Are you watching your diet?

Question

06/13/23 11:50 PM EDT

I don’t have any dietary restrictions or anything like that.

Do you have any side effects with the hypothyroidism medication?

Question

06/13/23 11:51 PM EDT

No, I haven’t had any side effects from the medication.

Do you have any medication allergies?

Question

06/13/23 11:52 PM EDT

I don’t have any allergies to any medications.

Are you allergic to any food?

Question

06/13/23 11:53 PM EDT

No, I don’t have food allergies.

Tell me about your salt intake levels

Question

06/13/23 11:53 PM EDT

I haven’t been abnormally thirsty or anything like that. Just a “normal” amount of thirsty. [AUDIO COMING SOON]

And how much amount of water do you consume?

Question

06/13/23 11:53 PM EDT

I’ll usually have between 6 and 7 glasses of water a day.

Have you been urinating more frequently? (No matching questions found.) Maureen Hopkins Sick Visit: Management of Endocrine Conditions Shadow health Transcript

Question

06/13/23 11:54 PM EDT

Any specific part of your body where you particularly feel dry? (No matching questions found.)

Question

06/13/23 11:55 PM EDT

Have you been hospitalized for hypothyroidism? (Clarified to What was your last hospitalization for?.)

Question

06/13/23 11:56 PM EDT

It was years and years ago, when I gave birth to my sons. (Clarified to what my last hospitalization was for.)

Are you up-to date with your vaccines?

Question

06/13/23 11:57 PM EDT

I believe I’m up to date on my immunizations, yes. [AUDIO COMING SOON]

Have you had any past surgeries?

Question

06/13/23 11:57 PM EDT

I’ve never had surgery.

Are you up-to date with your childhood immunizations?

Question

06/13/23 11:58 PM EDT

I believe I’m up to date on my immunizations, yes. [AUDIO COMING SOON]

Any family history of hypothyroidism?

Question

06/14/23 12:00 AM EDT

Not that I know — I don’t believe anyone had it, or at least knew about it.

Any family history of diabetes? (Clarified to Do your family members have health problems?.)

Question

06/14/23 12:00 AM EDT

The main thing was my father passed from COPD, from smoking. And my mother passed from a stroke. (Clarified to if my family members have health problems.)

On a scale of 0 to 10, can you rate your level of fatigue (No matching questions found.)

Question

06/14/23 12:02 AM EDT

What triggers you to feel tired?

Question

06/14/23 12:03 AM EDT

I’m not sure. I can’t pinpoint any causes or anything that makes me more tired.

How long have you been feeling tired?

Question

06/14/23 12:04 AM EDT

I started feeling this tired about a month ago.

Are there any other symptoms you are experiencing?

Question

06/14/23 12:05 AM EDT

Besides losing my hair and feeling so tired . . . I suppose my skin has been pretty dry.

Have you experiences hair loss before? (Clarified to Have you had hair loss in the past?.)

Question

06/14/23 12:05 AM EDT

No, I haven’t had hair loss before it started 3 weeks ago. [AUDIO COMING SOON] (Clarified to if I have had hair loss in the past.)

Have you had any injuries?

..

Have you had eye problems?

Question

06/16/23 5:39 PM EDT

My eyes and vision are fine. [AUDIO COMING SOON]

Any ear problems?

Question

06/16/23 5:40 PM EDT

My ears are doing fine. [AUDIO COMING SOON]

Have you had changes in your mouth and throat?

Question

06/16/23 5:40 PM EDT

Hm . . . well, I did notice a while back that my Synthroid looked different when I picked it up from the pharmacy. It was a sort of oblong pill shape, whereas it’s usually circular. And the pill bottle read “levothyroxine sodium,” instead of “Synthroid” like usual.

Have you had changes in frequency of urinating?

Question

06/16/23 5:41 PM EDT

Hm . . . well, I did notice a while back that my Synthroid looked different when I picked it up from the pharmacy. It was a sort of oblong pill shape, whereas it’s usually circular. And the pill bottle read “levothyroxine sodium,” instead of “Synthroid” like usual. Maureen Hopkins Sick Visit: Management of Endocrine Conditions Shadow health Transcript

Any pain when urinating? (Clarified to Do you have trouble urinating?.)

Question

06/16/23 5:41 PM EDT

I haven’t had any issues in the bathroom or the like. [AUDIO COMING SOON] (Clarified to if I have trouble urinating.)

Have you notes easy bruising or bleeding? (No matching questions found.)

Question

06/16/23 5:42 PM EDT

Do you experience pain when moving? (Clarified to Does it hurt to walk?.)

Question

06/16/23 5:43 PM EDT

No, not at all. I like walking. (Clarified to if it hurts to walk.)

Have you experienced any behavioral changes? (No matching questions found.)

Question

06/16/23 5:44 PM EDT

Have you experienced any dizziness? (No matching questions found.)

Question

06/16/23 5:44 PM EDT

Have you had a previous blood transfusion? (No matching questions found.)

Question

06/16/23 5:45 PM EDT

Have you had headaches?

Question

06/16/23 5:46 PM EDT

I haven’t had any headaches. [AUDIO COMING SOON]

Have you had changes in appetite?

Question

06/16/23 5:46 PM EDT

My appetite’s the same as it usually is. [AUDIO COMING SOON]

When was your last EKG screening? (Clarified to When was the last time you took any medications?.)

Question

06/16/23 5:47 PM EDT

I took my Synthroid this morning. [AUDIO COMING SOON] (Clarified to when I last took medication.)

Are you having hallucinations? (No matching questions found.)

Question

06/16/23 5:47 PM EDT

Which symptoms are associated with osteopenia? (No matching questions found.)

Question

06/16/23 6:09 PM EDT

Any family history of thyroid issues?

Question

06/16/23 6:09 PM EDT

Not that I know — I don’t believe anyone had it, or at least knew about it.

Any family history of autoimmune disorders?

Question

06/16/23 6:10 PM EDT

The main thing was my father passed from COPD, from smoking. And my mother passed from a stroke.

Have you had all childhood and adulthood immunizations? (No matching questions found.)

Question

06/16/23 6:10 PM EDT

Have you had all immunizations? (No matching questions found.)

Question

06/16/23 6:11 PM EDT

Any other symptoms associated with the skin? (Clarified to Do you have other symptoms when you have palpitations?.)

Question

06/16/23 6:14 PM EDT

I don’t have any palpitations. (Clarified to if I have other symptoms with my palpitations.)

How severe is your skin dryness? (Clarified to How severe is your dry skin?.)

Question

06/16/23 6:15 PM EDT

My dry skin is a little uncomfortable, but nothing too bad. (Clarified to how severe my dry skin is.)

How severe is your fatigue?

Question

06/16/23 6:15 PM EDT

If I had to rate my fatigue out of 10 . . . I’d say a 5 or 6. [AUDIO COMING SOON]

How are your menstrual patterns? (No matching questions found.)

Question

06/16/23 6:15 PM EDT

Definition Argument Essay Assignment

Goal

Write a
1,500-1,750-word essay
using
five to seven academic resources
in which you argue that a contested
“case”
fits (or does not fit) within a given category
. Follow the directions of your instructor as to what topics are acceptable.

Directions

Follow these steps when composing your essay:

BUY ESSAY HERE

Start by selecting a controversial or contested definitional case.

Decide what category you think your case belongs in, with the understanding that others may disagree with you about the definition of your category, and/or whether your chosen case matches your category.

In the opening of your essay, introduce the case you will examine and pose your definition question. Do
not
simply summarize here. Instead, introduce the issue and offer context.

To support your argument, define the boundaries of your category (criteria) by using a commonly used definition or by developing your own extended definition.
Defining your boundaries
simply means naming the criteria by which you will discuss your chosen case.

In the second part of your argument (the match), show how your case meets (or does not meet) your definition criteria. Perhaps by comparing or sizing up your controversial case to other cases can help you to develop your argument.

This essay is
NOT
simply a
persuasive essay
. It is an argumentative essay where the writer explains what a term means and uses a specific case to explore the meaning of that term in depth.

 

First Draft Grading

 

You will receive completion points for the first draft based upon the successful submission of a complete draft.

Because your first draft is a completion grade, do not assume that this grade reflects or predicts the final grade. If you do not consider your instructor’s comments, you may be deducted points on your final draft.

 

Final Draft Grading

 

The essay will be graded using a rubric. Please review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations.

 

Sources

 

Include in-text citations and a references page in
APA Style
for
FIVE to SEVEN
scholarly sources outside of class texts.

These sources should be used to support any claims you make and should be present in the text of the essay.

Use the GCU Library to help you find sources.

Include this research in the paper in a scholarly manner.

 

Format

 

Prepare this assignment according to the guidelines found in the
APA Style Guide
, located in the
Student Success Center
.

 

LopesWrite

 

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Please be sure your LopesWrite score is at an acceptable level before submitting the draft to your instructor.

Anita Douglas Conditions of the Hematologic System Differential Selection

Differential Selection 
: 1 of 1 (100.0%)

In this activity, you were asked to identify which differential diagnoses were essential to investigate to ensure patient safety. You were automatically evaluated by the simulation on whether or not you identified the appropriate list of 
Do-Not-Miss diagnoses.

Review the list of most appropriate Do-Not-Miss diagnoses below. Correct selections have been marked with a 
, while selections you missed have been marked with a 
.

GET HELP

Do Not Miss

Student Rationale

Model Rationale

 
Aplastic Anemia

You scored: 1 out of 1

Great job! You correctly identified this diagnosis as do not miss.

This is a possible diagnosis based on the provider notes Anita Douglas Conditions of the Hematologic System Differential Selection

Aplastic anemia is a high consequence differential. Causes of aplastic anemia can include infections, certain medicines, autoimmune diseases and exposure to toxic chemicals. Given Dr. Douglas’ presentation, recent recovery from pneumonia, and the potential risk posed to the patient if undiagnosed, this is a high value selection.

Other Differentials

You were asked to select other potential differential diagnoses that you thought were applicable to the case. Review the list of differential diagnoses below and compare your answers to Diana’s list. Your selections in this section are not automatically scored by the simulation, but your instructor may choose to grade this list.

Differential

Student Rationale

Model Rationale

 
Anemia of Chronic Disease

Great job
! This is an applicable diagnosis, given the patient case details and provider notes.

This is a possible diagnosis as based on the patient information and provider notes Anita Douglas Conditions of the Hematologic System Differential Selection.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, anemia of chronic disease (or anemia of inflammation) affects patients with inflammatory diseases, such as chronic kidney disease, which affect the body’s ability to use iron when making blood cells. Given Dr. Douglas’ medical history and presentation, this is a high-value selection for this scenario.

 
Hypothyroidism

Great job
! This is an applicable diagnosis, given the patient case details and provider notes.

This is a possible diagnosis based on the patient information and the provider notes Anita Douglas Conditions of the Hematologic System Differential Selection.

Cold sensitivity and fatigue are early signs of hypothyroidism. Hypothyroidism is also commonly seen in patients with chronic kidney disease. Given the full picture of the patient, this is an important differential to xxx

NRNP 6540 Week 3: Knowledge Check Quiz
Question 1

1 
/ 1
 pts

The NP is seeing a 76-year-old female patient wiht a lesion on her right arm that has been there for three years.   She states it alternately crusts and heals, and it began as a shiny papule, but now look like this.  What is your working diagnosis?

Melanoma

 

Squamous Cell Carcinoma

 

Correct!

Basal Cell Carcinoma

 

Merkel Cell Cancinoma

 

GET EXAM OR FULL CLASS HELP HERE

Question 2

1
/ 1
 pts

Cellulitis is most commonly caused by which pathogens?

staph epidermidis

 

Correct!

group A strep pyrogenes

 

Correct!

staph aureus

 

methicillin-resistant staph aureus

 

Question 3

1
/ 1
 pts

The NP is treating an immunocompetent  patient recovering from herpes zoster ophthalmicus.  The patient has asked if she should get a vaccine to prevent another herpes zoster outbreak.  What would you advise?

 

No need to get the vaccine since she has had herpese zoster and has immunity to it now

 

Correct!

   

Recommend recombinant herpes zoster vaccine to reduce the chance of recurrence.

 

 

Only one dose of recombinant vaccine is indicated following a herpes zoster outbreak

 

NRNP 6540 Week 3: Knowledge Check Quiz Question 4

1
/ 1
 pts

The NP has diagnosed a patient with herpes zoster ophthalmicus (HZO). What would your treatment plan for this patient be?

Correct!

valacyclovir 1 g po tid for 7 days

 

Correct!

referral to ophthalmologist

 

Correct!

topical corticosteroids

 

atropine 1% 1 drop to left eye tid

 

Question 5

1
/ 1
 pts

Describe the etiology of lymphedema.

Low blood albumin

 

Anemia

 

Correct!

 

Pooling of fluid in the interstitial space.

 

Renal insufficiency

 

Question 6

1 
/ 1
 pts

The NP is seeing a 71 year patient with a red and swollen area that measures 7 cm x 2 cm on his left lower leg.   The lestion is tender and warm to the touch.  He thinks his cat may have scratched him a few days ago.   The right lower leg appears normal.  What is your working diagnosis?

 

Insect bite

 

Thrombophlebitis

 

Drug reaction

 

Correct!

Cellulitis

 

NRNP 6540 Week 3: Knowledge Check Quiz Question 7

1 
/ 1
 pts

The NP is seeing an 82 year old male patient  who is a retired farmer.    He has multiple freckles over his face, arms, and back.   One of the freckles seems to be getting larger.  What is your working diagnosis?

 

Basal Cell Carcinoma

 

Squamous Cell Carcinoma

 

Merkel Cell Carcinoma

 

Correct!

Melanoma

 

Question 8

1
/ 1
 pts

The NP has diagnosed a 67 year old female patient with psoriasis.   What initial treatment would you prescribe?

 

Correct!

Hydrocortisone topical 2.5% apply to affected area 2 to 4 times daily

 

Correct!

Topical Vitamin D

 

Prednisone 10 mg one tab po qid

 

Methotrexate 25 mg po one a week

 

NRNP 6540 Week 3: Knowledge Check Quiz Question 9

1 
/ 1
 pts

The NP is seeing a 76 year old male patient.   He complains of peeling skin and itching mainly between his toes.   What is your working diagnosis?

 

 

Psoriasis

 

Correct!

Tinea pedis

 

Yeast infection

 

Eczema

 

Question 10

1 
/ 1
 pts

What is the best way to diagnose tinea infections?

Bacterial culture

 

Response to steroid cream appliation

 

Correct!

KOH examination of skin scrapings

Most test analysis programs report the mean, or arithmetic average, of the raw scores on the test; in this case (Table 11.1), it is 75.4. The mean percent score is determined by dividing the mean raw score by the total number of items on the test. The mean percent score is equal to the mean raw score in this example because there are 100 items on the test.

One disadvantage of the mean is that it is sensitive to extreme scores. An extreme score, whether very high or very low, can pull the mean toward its direction. This effect is particularly problematic when there is a small group of scores (Reynolds, Livingston, & Wilson, 2008).

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For example, let’s look at the distributions in Table 11.2. Each distribution has an extreme score of 15, yet the smaller number of scores is affected more dramatically than the larger number of scores. The mean of the “A Scores” is 7.4, a score that does not even appear in the distribution, while the score of 15 has a less dramatic effect on the mean of the “B Scores,” which is 5.95. It is obvious from these examples that you must consider the effect of extreme scores when interpreting the mean on a test.

It is important to examine the relationship of the mean to the passing standard that you have set. If, for example, your passing standard is 75%, this test has an average score at the passing level. Several factors must be considered when interpreting the mean:

Were there extreme scores in the distribution?

What was the quality of teaching, on a range between effective and ineffective?

What was the students’ level of effort to achieve the outcomes, on a range between maximal and minimal?

Where did the material/objectives fit, on a range between too easy and too difficult?

How difficult were the items, on a range between too easy and too hard?

If a test has a very low mean, you should investigate whether there is a problem with one of the questions listed above. As Haladyna (1997) points out, if you intentionally give difficult tests, you should adjust your grading policy to ensure that you assign grades fairly in relation to the other courses that students take. Similar consideration should be made if your tests are consistently too easy. The ideal goal is to have a test with a mean that reflects a range of student abilities. A test should be neither too easy nor too difficult, but should reward those students who are high achievers and should identify those who have not met the course objectives. Chapter 13, “Assigning Grades,” discusses the issues surrounding grade assignment.

NRNP 6540 Week 1: Knowledge Check Quiz 100% correct answers

Question 1

1
/ 1
 pts

When would the influenza vaccine be absolutely contraindicated?

Correct!

 

A previous severe allergic reaction to influenza vaccine

 

Correct!

 

A severe allergic reaction to eggs

 

Progressive allergic reaction symptoms

 

Skin induration greater than 10 mm

 

Question 2

1 
/ 1
 pts

A 66 year old patient is planning  a trip abroad.   He looked at the CDC web site and found that yellow fever is recommended but only for people age 1 to 59.    He wants to know why he shouldn’t get the vaccine?

People 60 and older are not at risk for developing yellow fever

 

Correct!

Risk for severe side effects from the vaccine are higher in people 60 and over

 

The effects of the disease are less than the side effects of the vaccine in people age 60 and over

 

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Question 3

1
/ 1
 pts

What is the maximum number of doses of PPSV23 that can be given to high-risk older adults 65 or older?

You Answered

one

 

two

 

Correct!

three

 

four

 

NRNP 6540 Week 1: Knowledge Check Quiz 100% correct answers Question 4

1
/ 1
 pts

What immunizations you would give to your 65-year-old patient with HIV infection and a CD4 count of 200/mm or less?

 

Correct!

Quadrivalent high dose inactivated influenza vaccine

 

MMR

 

Correct!

Tdap

 

Correct!

Hepatitis A

 

Question 5

1 
/ 1
 pts

The NP sees a 69-year-old patient who recently moved to town and does not remember his last tetanus shot.   The patient did not receive any immunizations as a child.    What would you do?

One dose of Td now

 

One dose of Tdap now

 

One dose of Td now and then one dose of Tdap in 4 weeks

 

Correct!

One does of Tdap now, one dose of Td in 4 weeks, and another dose of Td in 6-12 months.

 

NRNP 6540 Week 1: Knowledge Check Quiz 100% correct answers Question 6

1
/ 1
 pts

The NP is caring for older adults in a nursing home. As a general rule, patients over 65 years of age and in general good health can receive which immunizations?

Correct!

Quadrivalent high dose inactivated influenza vaccine

 

Correct!

Two doses of RZV administered 2 to 6 weeks apart

 

Correct!

Tdap

 

Correct!

PCV 15

 

Question 7

1
/ 1
 pts

What are the three types of influenza vaccines available?

Correct!

Inactivated influenza vaccine (IIV)

 

Correct!

Recombinant influenza vaccine (RIV)

 

Correct!

Live attenuated influenza vaccine (LAIV).

 

Live Recombinant influenza vaccine

 

Question 8

1
/ 1
 pts

The NP is monitoring the immune response following hepatits B vaccination in an elderly hemodialysis patient.  What test should be ordered and when to assess the immune response?

HBsAg completed 6 months after the last dose

 

HBsAg completed 1 month after second dose

 

Correct!

 

HBsAb completed 2 months after the last dose

 

HBsAb completed 6 months after 2nd dose

 

Question 9

1
/ 1
 pts

The NP sees a 66-year-old patient who is immunocompromised, and their penumococcal 
vaccine history is unknown
.  According to the CDC, what would you recommend for pneumococcal vaccination?

You Answered

 

One dose of PCV15 now and 1 dose of PPSV23 in one year.

 

One dose of PPSV23 now and one dose of PCV15 in one year

 

Correct!

One dose of PCV15 now and 1 dose of PPSV23 in eight weeks

 

One dose of PPSV23 now and 1 does of PCV15 in 8 weeks.

 

Question 10

1
/ 1
 pts

What are the most current recommendations for vaccination of patients near the end of life, including hospice patients?

Hospice patients should get the same vaccinations as everyone else

 

No vaccinations are recommended for hospice patients

 

Correct!

Each patient should be considered on a case by case basis.

NRNP 6540 Week 1: Knowledge Check Quiz 100% correct answers

Median

The median in this sample is 77, which represents the middle point in this group of raw scores. In a normal distribution, the
mean
and the median are the same. If a distribution is positively skewed, meaning that the test is very difficult, with most scores at the low end of the distribution and few very high scores, the mean is pulled to the positive end of the distribution and is higher than the median (Reynolds et al., 2008).A positively skewed distribution, such as the one depicted in Figure 11.1, signals a problem. Why are there so few high scores? What went wrong in the instructional process?

If a distribution is negatively skewed, it means the test was easy for the group, with most scores at the high end of the distribution and few very low scores. The distribution depicted in Figure 11.2 is one you might expect in a nursing class. After all, all students who are admitted to a nursing program are capable of achieving the objectives.

fig 11.2

The mean in a negatively skewed distribution is pulled toward the negative end of the distribution and is lower than the median (Reynolds et al., 2008). Therefore, the mean can give the wrong impression whenever a distribution is seriously skewed. The terms positively skewed and negatively skewed can seem counterintuitive. Remember this tip: A “positively” skewed distribution has its tail in the positive end of the distribution, while a “negatively” skewed distribution has its tail in the negative end of the distribution. A distribution that is not skewed has the same or very close values for the mean and the median; it resembles a bell and is referred to as a normal distribution or a bell curve.The mean and median in the example of Table 11.1 are close, which means there are probably not many extreme scores in the distribution and the mean is close to the median. The mean in this case can be interpreted as representing a typical score. Of course, you should review the score distribution, which is also included in the test analysis report, before you decide whether the mean actually represents a typical score. Interpretation of graphic and frequency distributions is discussed later in this chapter.

NURS 6630 Week 3: Self Assessment Quiz with 100% correct answers

Question 1

G-protein coupled receptors are targets for several psychiatric medications. Given what we know about these receptors, what is the ultimate result we will see when one of them is activated in a way that would potentiate an action?

A. Intracellular activation of second messengers

 

B. Protein phosphorylation

 

Correct!

C. Modification of gene expression

 

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A and B are both steps in the activities seen leading up to modification of gene expression.

Question 2

Upon blocking a Serotonin reuptake pump, what happens in the synaptic cleft and on the post synaptic cell membrane?

A. The result will be an increase in available Serotonin in the synaptic cleft causing the post synaptic cell to increase the number of Serotonin receptors.

 

Correct!

B. The result will be an increase in the available Serotonin in the synaptic cleft causing the post synaptic neuron to reduce the number of Serotonin receptors.

 

C. The result will be an increase in Serotonin in the synaptic cleft resulting in an increase in reuptake pumps on the presynaptic neuron.

 

D. The result will be an increase in Serotonin in the synaptic cleft resulting in a decrease in reuptake pumps on the pre-synaptic neuron. NURS 6630 Week 3: Self Assessment Quiz with 100% correct answers

 

A, C, and D are misrepresentations of what occurs when you increase Serotonin in the synaptic cleft. There is no effect on the pre-synaptic neuron, and the increases in Serotonin result in a reduction of receptor concentration on the post-synaptic neuron.

Question 3

Motivation is a component of patient-focused interventions to enhance adherence. Based on the transtheoretical model, readiness to change can fluctuate across five stages. Which stage is represented by the patient who is aware that a problem exists and, while seriously thinking about overcoming it, has not yet committed to a plan of action?

Preparation

 

Action

 

Correct!

Contemplation

 

Maintenance

 

Question 4

Receptors trigger one of two effector pathways resulting in changes in neuronal activity. These changes will, ultimately, effect gene expression. Which effector pathway is characterized by ion flux through transmitter-activated channels resulting in an altered membrane potential and neuronal activity?

A. Slow effector pathways

 

B. Modulated effector pathways

 

Correct!

C. Rapid effector pathways

 

D. NMDA glutamate receptor pathways

 

Answer B is fictitious, D is a type of rapid effector pathway, and A represents G-protein coupled receptors.

Question 5

Of the components of patient-focused interventions to enhance adherence, which component includes the following strategies: adaptive thinking, use of cues, and support?

Motivation

 

Correct!

Skills

 

Logistics

 

Education

 

Skills include adaptive thinking, problem solving, use of cues, and support.

Question 6

Treatment adherence is affected by several different factors. Clinical factors include mood, anxiety, psychosis, and substance misuse. There are also patient factors such as knowledge, attitude, and beliefs; economic and racial/ethnic disparities, and clinical encounters. A patient who presents hopeless, with decreased energy, and poor concentration is affected by which factor?

Substance misuse

 

Knowledge deficits

 

Attitude ad belief system

 

Correct!

Mood

 

These are signs of an altered mood.

Question 7

Neurotransmitters are defined by four essential characteristics. These are:

A. Neurotransmitters are synthesized within presynaptic neurons. NURS 6630 Week 3: Self Assessment Quiz with 100% correct answers

 

B. Depolarization of a neuron results in the release of a neurotransmitter, which exerts a multitude of actions on the postsynaptic neuron.

 

C. Their action on postsynaptic neurons can be replicated by administering a drug that mimics the activity of the endogenous neurotransmitter.

 

D. Their action in the synaptic cleft is terminated by a specific action.

 

Correct!

E. A, C, and D only

 

Answer B should read a “discrete” (not multitude) action on the post synaptic neuron.

Question 8

Neurotransmission is unidirectional insofar as chemical and electrical conduction is concerned within the individual neuron. Of the following descriptions, which best characterizes the order of neurotransmitter/receptor interaction that results in an electrical signal impulse and the release of another neurotransmitter for interaction in the synaptic cleft (signal conduction through a neuron)?

Cell body, dendrites, Axon, Axon terminals

 

Dendrites, Axon, Cell body, Axon, Axon terminals

 

Correct!

Dendrites, Cell body, Axon, Axon terminals

 

Axon terminals, Axon, Cell body, Dendrites

 

All of the other options are mis-sequenced in signal conduction.

Question 9

The synaptic cleft is best characterized by which of the following statements?

A. The synaptic cleft is the space between a single neuron’s dendrites and axon terminals in which intracellular communication occurs through the release of neurotransmitters allowing for signal conduction throughout the central nervous system.

 

B. The synaptic cleft is the space between the cell body and axon terminals that allows for release of neurotransmitters from the presynaptic neuron for intercellular communication with an adjacent neuron (post synaptic neuron).

 

Correct!

C. The synaptic cleft is an area where dendrites and axon terminals are within close proximity, allowing for the release of a neurotransmitter from a presynaptic neuron that can interact with receptors on dendritic cells of a post synaptic neuron, which is the main basis for intercellular communication of neurons.

 

Answer A represents a neuron communicating with itself and Answer B states that the synapse is the space between the cell body (not dendrites) and axon terminals.

Question 10

The human brain is subcategorized into four major structures. These structures include the cerebral cortex, brainstem, subcortical structures, and the cerebellum. Of these major categories, which one houses the area of the brain that has been found in some neuropathological studies of patients with schizophrenia to be of smaller size?

Cerebral cortex

 

Brainstem

 

Correct!

Subcortical structures

 

Cerebellum

 

The area of the brain in question is part of the thalamus, which is located in the subcortical structures. The other options are incorrect, geographically speaking. NURS 6630 Week 3: Self Assessment Quiz with 100% correct answers

Question 11

1
Neurons are classified in several different ways. From the following statements, select which ones are true.

The two structural classifications are projection neurons and local inter-neurons.

Function classifications are made up of two subcategories: excitatory and inhibitory.

Histological classification includes bipolar, unipolar, and multipolar.

Classifications using a combination of structural, functional, and neurotransmitter type provide the most robust and useful description.

Classification by neurotransmitter type alone provides the most useful description.

I only

III only

I, II, and V only

 

I, II, III, IV, and V

Correct!

I, III, and IV

Statement II would need to include modulatory function to be correct, and Statement V does not include structural and functional classification systems.

Question 12

Which of the following consists of all the known major neurotransmitters that are relevant in psychiatry?

glutamate, GABA, dopamine, serotonin, norepinephrine, histamine, steroids, nitric oxide

 

Correct!

glutamate, GABA, dopamine, norepinephrine, serotonin, acetylcholine, histamine, endogenous opioids, steroids, cannabinoids, nitric oxide

 

glutamate, GABA, dopamine, serotonin, acetylcholine, endogenous opioids, nitric oxide, cannabinoids, steroids

 

glutamate, GABA, dopamine, serotonin, norepinephrine, endogenous opioids, steroids, histamine, nitric oxide

 

all the other options are missing neurotransmitters considered important in psychiatry

Question 13

G-protein coupled receptors are examples of what type of effector pathway?

Correct!

A. Slow effector pathways

 

B. Rapid effector pathways

 

C. NMDA glutamate receptor pathways

 

D. Modulated effector pathways

 

Answer D is fictitious, B represents ion channel receptors, and C is a type of rapid effector pathway.

Question 14

Which neurotransmitter is considered the major excitatory neurotransmitter?

A. Glycine

 

B. GABA

 

Correct!

C. Glutamate

 

D. Serotonin

 

A and B are inhibitory, and D is involved in mood and sleep.

Question 15

Glia cells play a supportive role to the neuron. A few of the functions of the glial cells include providing nutrition, maintaining homeostasis, stabilizing synapses, and myelinating axons. The glial cells are categorized as microglia and macroglia. Of these two cell types, which one plays an active and critical role in glutamatergic neurotransmission by providing a co-agonist required for glutamate receptor function?

microglial

 

Correct!

macroglial

 

Microglial cells are small, phagocytic cells related to peripheral macrophages.

Question 16

If a patient admits to taking his medication every other day (instead of daily, as prescribed), a potential concern would be:

A. Sufficient understanding or acceptance of the illness

 

B. Abuse of the medication

 

Correct!

C. Expense

 

D. Is the desired effect recognized at a lower daily dose? NURS 6630 Week 3: Self Assessment Quiz with 100% correct answers

 

A represents a patient taking his medication sporadically, B represents a patient taking too much medication, and D represents a patient taking a lower-than-prescribed dose but daily

Question 17

When dopamine (subtype 2) receptors are blocked in this pathway (system), it is evident by EPS.

A. Mesocortical

 

B. Tuberoinfundibular

 

Correct!

C. Nigrostriatal

 

D. Mesolimbic

 

D is associated with positive symptoms in schizophrenia, B is associated with lactation, A is associated with affect.

Question 18

Introducing adherence in facilitating treatment goals is something that would be necessary in a patient who has previously displayed nonadherence patterns.

True

 

Correct!

False

 

It is introduced as early as possible in treatment to mitigate the risks associated with nonadherence.

Question 19

A patient arrives in the ED via EMS having a grand mal seizure. The ED physician instructs the RN to give 10 milligrams of Diazepam IV X1 dose STAT. The patient’s seizure breaks within 2 minutes of the Diazepam being administered. The mechanism by which this medication causes rapid resolution of seizure activity is via which receptor type (effector pathway/receptor subtype)?

A. Slow effector pathways/G-protein coupled receptor

 

B. Slow effector pathway/ion channel

 

C. Rapid effector pathways/G-protein coupled receptor

 

Correct!

D. Rapid effector pathway/ion channel

 

Options B and C are mismatched, and Option A shows effects days to weeks after activation.

Question 20

Serotonin (5HT) is a neurotransmitter associated with mood, sleep, and psychosis. There are several serotonin receptors all over the human body. A unique aspect of the second generation antipsychotics is their ability to block 5HT2a receptors. What is the effect of this inhibition?

Correct!

A. Stabilizes dopamine concentrations in the CNS

 

B. Induces anxiety

 

C. Causes hallucinations

 

D. Reduces platelet function

 

B represents antagonism of 5HT1a, C represents a 5HT2a agonist, and D represents what happens when you inhibit SERT. NURS 6630 Week 3: Self Assessment Quiz with 100% correct answers