Case #1: Jane

Jane is a 42-year-old G4P2103. Jane is divorced and works long, hard hours as a real estate agent. Jane was having irregular and heavy menses for 6 months, and then they abruptly stopped 3 months ago. Jane has been having nausea and vomiting for 6 weeks but attributed it to having the flu recently. She also admits to gaining about 10 pounds in the last few months and experiencing breast tenderness. Jane comes to the clinic today to discuss menopause symptoms and treatment. During the visit, a urine pregnancy test came back positive. During the exam, you palpate a 16-week-size uterus and get fetal heart tones of 165. Jane is in disbelief. 

Case #2: Natalie

Natalie is a 27-year-old G4P0120. Natalie is married; she and her husband both work two part-time jobs to cover the bills. Natalie presents to your office at about 20 weeks gestation for her initial OB visit. Natalie states she has not been evaluated prior to today for the pregnancy because of lack of funds and ability to get off work. Natalie also complains of multiple yeast infections during this pregnancy. During your interview with Natalie, you find she has no known medical diagnoses, she is not taking medications, she is a smoker, and she has a negative surgical history. Natalie’s OB history includes two spontaneous losses at 8 and 12 weeks gestation and a loss of a 32 weeks infant following premature rupture of membranes. The 32-week infant was 7 pounds; lived 24 hours; and experienced hypoglycemia, respiratory distress, and ultimately died of sepsis. Natalie tells you she waited to seek prenatal care until this point because she did not have enough money to pay for the visit. She and her husband are still paying off medical expenses from the death of their 32-week infant. She tells you that she probably would have waited longer, but she keeps getting these terrible yeast infections. On exam, you note a fundal height of 26 weeks and urine dip reveals 1+ leukocytes, 1+ protein, trace blood and 3+ glucose.

Case #3: Katie

Katie is a 17-year-old G1P0. She presents to your office with four missed periods in a row. Katie is a high school student; she is in the 10th grade. She lives with her mother and four siblings. You ask Katie about the father of the baby and she tells you he states, “that baby is not mine.” They are not speaking to each other right now. Katie tells you she has been “vomiting a lot and her stomach hurts when she pees.” A urine pregnancy test comes back positive. Katie is so confused because she has been using douching after intercourse as her method of birth control. Katie’s past medical history is positive for chlamydia twice in the last year. She was treated at the Health Department but never went back for a follow up. Katie has had no surgeries and is on no medication. When asked, Katie states her last known weight was about 120 lbs. Katie’s V/S are BP 110/70, temp 102.5, weight 107. You note enlarged cervical lymph nodes, FHTs are 160, and fundal height is 18. Katie’s urine reveals 2+ ketones, 2+ nitrates, and 3+ leukocytes.

Case #4: Sara

Sara is a 32-year-old G1P1001. She presents to your office for a 6-week postpartum check following a normal vaginal delivery of a healthy baby girl. Sara had an 18-hour labor with Pitocin augmentation and delivered a 7 pound 2 oz. girl with a second-degree laceration repaired with sutures. Sara spent 2 days in the hospital and was discharged home with her infant and husband. Over the last few weeks, Sara has called the office multiple times with questions about breastfeeding and her sutures healing. Upon walking into the exam room to see Sara, you see her baby in the stroller crying and Sara sitting on the exam table crying into her hands. 

Download and complete the Pregnancy Case Review Chart. 

• Make sure to address all sections. Do NOT leave any section blank.
• Include relevant subjective and physical objective findings.
• Identify appropriate diagnostic and laboratory testing needed.
• List at least three differential diagnoses with rationales for choosing.
• Identify usual medications, treatments, or patient education needed.
• Determine referrals for collaborative care.
• Provide evidence-based references in APA formatting. Consult with the Writing Center as needed.

Assignment Requirements

Before finalizing your work, you should:

Be sure to read the Assignment description carefully (as displayed above).

• Consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary.
• Utilize spelling and grammar check to minimize errors.
• Follow the conventions of Standard English (correct grammar, punctuation, etc.)
• Be well ordered, logical, and unified, as well as original and insightful
• Displays superior content, organization, style, and mechanics.
• Use Evidence-Based Practice guidelines.
• Utilize APA formatting.

Take Test: Module 2 Knowledge Check

Test Information

DescriptionInstructionsMultiple AttemptsNot allowed. This test can only be taken once.Force CompletionThis test can be saved and resumed later.

Question Completion Status:

QUESTION 1

1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
   HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
   Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
   His diagnosis is an acute inferior wall myocardial infarction.
   1 of 2 Questions:
   Why is HDL considered the “good” cholesterol?

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2 points   

QUESTION 2

1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
   HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
   Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
   His diagnosis is an acute inferior wall myocardial infarction.
   2 of 2 Questions:
   Explain the role inflammation has in the development of atherosclerosis.

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3 points   

QUESTION 3

1. A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.

   Question:

   What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?

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1 points   

QUESTION 4

1. A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu didn’t seem to work. States had a slight sore throat a couple weeks ago and attributed it to the flu. Physical exam revealed thin young man who appears to be uncomfortable but not acutely ill. Posterior pharynx reddened and tonsils 3+ without exudate. + anterior and posterior cervical lymphadenopathy. Tachycardic and a new onset 2/6 high-pitched, crescendo-decrescendo systolic ejection murmur auscultated at the left sternal border. Rapid strep +. The patient was diagnosed with acute rheumatic heart disease (RHD).

   Question:

   Explain how a positive strep test has caused the patient’s symptoms.

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1 points   

QUESTION 5

1. The APRN sees a 74-year-old obese female patient who is 2 days post-op after undergoing left total hip replacement. The patient has had severe post op nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says she feels like the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).
   Question:
   Describe the factors that could have contributed to the development of a DVT in this patient explain how each of the factors could cause DVT.

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1 points   

QUESTION 6

1. A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. The APRN suspects the patient experienced a massive pulmonary embolus.

   Question:

   Explain why a large pulmonary embolus interferes with oxygenation.

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1 points   

QUESTION 7

1. A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. While waiting for the Emergency Medical Service (EMS) to arrive, the APRN places EKG leads and the EKG demonstrates right ventricular strain.

   Question:

   Explain why a large pulmonary embolism causes right ventricular strain.

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1 points   

QUESTION 8

1. A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home. The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response.

   Question 1 of 2:

   Explain early asthmatic responses and the cells responsible for the responses.

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2 points   

QUESTION 9

1. A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home. The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response.
   Question 2 of 2:
   Explain late asthmatic responses and the cells responsible for the responses.

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2 points   

QUESTION 10

1. A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema.  He asks the APRN if this means he has COPD.
   Question 1 of 2:
   Explain the pathophysiology of emphysema and how it relates to COPD.

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2 points   

QUESTION 11

1. A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema.  He asks the APRN if this means he has COPD.
   Question 2 of 2:
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2 points   

QUESTION 12

1. Mr. Jones is a 78-year-old gentleman who presents to the clinic with a chief complaint of fever, chills and cough. He also reports some dyspnea. He has a history of right sided CVA, COPD, dyslipidemia, and HTN. Current medications include atorvastatin 40 mg po qhs, lisinopril, and fluticasone/salmeterol. He reports more use of his albuterol rescue inhaler.

   Vital signs Temp 101.8 F, pulse 108, respirations 21. PaO2 on room air 86% and on O2 4 L nasal canula 94%. CMP WNL, WBC 18.4. Physical exam reveals thin, anxious gentleman with mild hemiparesis on left side due to CVA. HEENT WNL except for diminished gag reflex and uneven elevation of the uvula, CV-HR 108 RRR without murmurs, rubs, or click, no bruits. Resp-coarse rhonchi throughout lung fields. CXR reveals consolidation in right lower lobe. He was diagnosed with community acquired pneumonia (CAP).
   Question:

   Patient was hypoxic as evidenced by the low PaO2. Explain the pathologic processes that caused this patient’s hypoxemia.

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1 points   

QUESTION 13

1. A 64-year-old woman with moderately severe COPD comes to the pulmonary clinic for her quarterly checkup. The APRN reviewing the chart notes that the patient has lost 5% of her body weight since her last visit. The APRN questions the patient and patient admits to not having much of an appetite and she also admits to missing some meals because it “takes too much work” to cook and consume dinner.

   Question:

   The APRN recognizes that COPD has a deleterious effect on patients. Explain why patients with COPD are at risk for malnutrition.

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1 points   

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