Discussion: Primary Care Practice for Evaluation
Discussion: Primary Care Practice for Evaluation
Discussion: Primary Care Practice for Evaluation
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NSG6420 Week 3 Quiz Latest 2017 (All are correct)
QuestionWeek 3 quizQuestion 1. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process?Seasonal allergiesAcute bronchitisBronchial asthmaChronic bronchitisQuestion 2. A patient presents complaining of a 5 day history of upper respiratory symptoms including nasal congestion and drainage. On the day the symptoms began he had a low-grade fever that has now resolved. His nasal congestion persisted and he has had yellow nasal drainage for three days associated with mild headaches. On exam he is afebrile and in no distress. Examination of his tympanic membranes and throat are normal. Examination of his nose is unremarkable although a slight yellowish-clear drainage is noted. There is tenderness when you lightly percuss his maxillary sinus. What would your treatment plan for this patient be?Observation and reassuranceTreatment with an antibiotic such as amoxicillinTreatment with an antibiotic such as a fluoroquinoline or amoxicillin-clavulanateCombination of a low dose inhaled corticosteroid and a long acting beta2 agonist inhaler.Question 3.Emphysematous changes in the lungs produce the following characteristic in COPD patients?Asymmetric chest expansionIncreased lateral diameterIncreased anterior-posterior diameterPectus excavatumQuestion 4. When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction:No palpable vibration is feltDecreased fremitus is feltIncreased fremitus is feltVibration is referred to the non-obstructed lobeQuestion 5. Your patient presents with complaint of persistent cough. After you have finished obtaining the History of Present Illness, you realize that the patient may be having episodes of wheezing, in addition to his cough. The most common cause of cough with wheezing is asthma. What of the following physical exam findings will support your tentative diagnosis of asthma?Clear, watery nasal drainage with nasal turbinate swellingPharyngeal exudate and lymphadenopathyClubbing, cyanosis and edema.Diminished lung sounds with rales in both basesQuestion 6.Which of the following imaging studies should be considered if a pulmonary malignancy is suspected?Computed tomography (CT) scanChest X-ray with PA, lateral, and lordotic viewsUltrasoundPositron emission tomography (PET) scanQuestion 7. A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to:Exercise-induced coughBronchiectasisAlpha-1 deficiencyPericarditisQuestion 8. Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to:PneumothoraxPleural effusionPneumoniaPulmonary embolismQuestion 9. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner.Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely?Pulmonary edemaHeart failurePulmonary embolismPneumoniaQuestion 10. A cough is described as chronic if it has been present for:2 weeks or more8 weeks or more3 months or more6 months or moreQuestion 11. Testing is necessary for the diagnosis of asthma because history and physical are not reliable means of excluding other diagnoses or determining the extent of lung impairment. What is the study that is used to evaluate upper respiratory symptoms with new onset wheeze?Chest X-rayMethacholine challenge testSpirometry, both with and without bronchodilationVentilation/perfusion scanQuestion 12. In classifying the severity of your patient presenting with an acute exacerbation of asthma. You determine that they have moderate persistent symptoms based on the report of symptoms and spirometry readings of the last 3 weeks. The findings that support moderate persistent symptoms include:Symptoms daily with nighttime awakening more than 1 time a week. FEV1 >60%, but predicted <80%. FEV1/FVC reduced 5%Symptoms less than twice a week and less than twice a week nighttime awakening. FEV1 >80% predicted. FEV1/FVC normalSymptoms more than 2 days a week, but not daily. Nighttime awakenings 3-4 times a month. FEV1 >80% predicted. FEV1/FVC normalSymptoms throughout the day with nighttime awakenings every night. FEV1< 60% predicted. FEV1/FVC reduced >5%Question 13. The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home:Age over 40Fever greater than 101Tachypnea greater than 30 breaths/minuteProductive coughQuestion 14. Medications are chosen based on the severity of asthma. Considering the patient that is diagnosed with moderate persistent asthma, the preferred option for maintenance medication is:High-dose inhaled corticosteroid and leukotriene receptor antagonistOral corticosteroid—high and low dose as appropriateShort acting beta2 agonist inhaler and theophyllineLow dose inhaled corticosteroid and long acting beta2 agonist inhalerQuestion 15. A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient:Can be treated as an outpatientRequires hospitalization for treatmentRequires a high dose of parenteral antibioticCan be treated with oral antibioticsQuestion 16. Which of the following is considered a “red flag” when diagnosing a patient with pneumonia?Fever of 102Infiltrates on chest X-rayPleural effusion on chest X-rayElevated white blood cell countQuestion 17. A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following:Barrel-shaped chestClubbingPectus excavatumProlonged capillary refillQuestion 18. Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect:Legionnaires’ diseaseMalariaTuberculosisPneumoniaQuestion 19. A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of:Lung cancerTuberculosisPneumoniaCOPDQuestion 20. A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident.Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect:Pulmonary embolismPleural effusionPneumothoraxFracture of ribs
Discussion: Primary Care Practice for Evaluation
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Discussion: Primary Care Practice for Evaluation
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
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