(11) Moral Dilemmas … Can Ethics Help? – YouTube 

youtube.com/watch?v=fJ9ttMAQr_A

I need to see this video on Youtube.

Judge the medical case in this video. Apply VIRTUE ETHICS theory that is based on the Aristotle and Function argument. 

 6 paragraphs (3 parents, 3 doctors), apply only one ethical theory( VIRTUE ETHICS) to decide the moral course of action in the medical case of the premature twins. Apply the VIRTUE ETHICS theory in each paragraph to support your arguments throughout the entire essay. Discuss the virtues involved.

NOT USING THE ETHICAL THEORY RESULTS IN AN AUTOMATIC ZERO.

I need a TURNITIN REPORT

Instructions

In this assignment, you will be required to use the Heart Rate Dataset to complete the following:

• Identify the variables in the dataset.
• Classify each variable as qualitative or quantitative discrete or quantitative continuous
• Specify the possible values of each variable
• Give a brief written description of what each variable tells us about the data provided.

Steps

1. Open the Heart Rate Dataset in Excel
2. There are 3 columns of data. Each column represents a different variable.  What are the 3 variables represented in the dataset?
3. Identify each of the 3 variables as qualitative, quantitative discrete, or quantitative continuous.
4. Identify the possible values of each of the 3 variables in this dataset.
5. Briefly describe what information each of the 3 variables tells us about the data.

Additional Instructions:

Your assignment should be typed into a Word or other word processing document, formatted in APA style. The assignments must include

• HeartRateDataSetrevised.xlsx

 

• Develop a 2–5-page training strategies summary and annotated agenda for a training session that will prepare a role group to succeed in implementing your proposed organizational policy and practice guidelines.
  Training and educating those within an organization who are responsible for implementing and working with changes in organizational policy is a critical step in ensuring that prescribed changes have their intended benefit. A leader in a health care profession must be able to apply effective leadership, management, and educational strategies to ensure that colleagues and subordinates will be prepared to do the work that is asked of them.
• As a master’s-level health care practitioner, you may be asked to design training sessions to help ensure the smooth implementation of any number of initiatives in your health care setting. The ability to create an agenda that will ensure your training goals will be met, and will fit into the allotted time, is a valuable skill for preparing colleagues to be successful in their practice.
  Competency Map
  CHECK YOUR PROGRESSUse this online tool to track your performance and progress through your course.
• Assessment Instructions
• Note: Remember that you can submit all, or a portion of, your draft strategy summary and annotated training agenda to Smarthinking for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
  To help ensure a smooth roll out and implementation of your proposed policy and practice guidelines, design a training session for one of the role groups in the organization that will be responsible for implementation.
  
  • Write a brief summary of your strategies for working with your chosen role group.
  • Explain how this training session will help prepare the group to succeed in implementing your proposed policy and practice guidelines, and why you chose this group to pilot your proposal.
  • Prepare an annotated agenda for a two-hour training session.
  • During this training session, you will want to ensure that the individuals you are training understand the new policy and practice guidelines. You will need them to buy into the importance of the policy in improving the quality of care or outcomes and their key role in successful policy implementation. You must help them acquire the knowledge and skills they need to be successful in implementing the policy and practice guidelines.
    As outcomes of this training session, participants are expected to:
  • Understand the organizational policy and practice guidelines to be implemented.
  • Understand the importance of the policy to improving quality or outcomes.
  • Understand that, as a group, they are key to successful implementation.
  • Possess the necessary knowledge and skills for successful implementation.
  • Requirements
    The strategy summary and annotated training agenda requirements outlined below correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, be sure to note the requirements for document format and length and for supporting evidence.
  • Summarize evidence-based strategies for working with the role group to obtain their buy-in and prepare them to implement the new policy and apply the associated practice guidelines to their work.
    • Why will these strategies be effective?
    • What measures might provide early indications of success?
  • Explain the impact of the new policy and practice guidelines.
    • How they will be implemented?
    • How will they affect the daily work routines and responsibilities of the role group?
  • Justify the importance of the new policy and practice guidelines with regard to improving the quality of care or outcomes related to the role group’s work.
    • How will the policy and guidelines help improve the quality of care or outcomes?
  • Explain the role group’s importance in implementing the new policy and practice guidelines.
    • Why is the work and buy-in of the role group important for successful implementation?
    • How could you help the group feel empowered by their involvement during implementation?
  • Determine appropriate and effective instructional content, learning activities, and materials for the training session.
    • How will each proposed activity on your agenda support learning and skill development?
    • Can you complete the training within the allotted two hours?
  • Organize content so ideas flow logically with smooth transitions.
    • Proofread your strategy summary and training agenda, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your strategies.
  • Support main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.
    • Be sure to apply correct APA formatting to source citations and references.
  • Example Assessment: You may use the Assessment 4 Example [PDF] to give you an idea of what a Proficient or higher rating on the scoring guide would look like.
    Strategy Summary and Training Agenda Format and Length
    Format your document using APA style.
  • Use the APA Style Paper Template [DOCX]. The APA Style Paper Tutorial [DOCX] will help you in writing and formatting your strategy summary and agenda. Be sure to include:
    • A title page and references page. An abstract is not required.
    • A running head on all pages.
    • Appropriate section headings.
  • Your strategy summary and agenda should be 2–5 pages in length, not including the title page and references page.
  • Supporting Evidence
    Cite 2–4 external sources to support your strategies for working with the group you have identified and generating their buy-in, as well as for your approach to the training session, activities, and materials.
    Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.
    Portfolio Prompt: You may choose to save your strategy summary and agenda to your ePortfolio.
    Competencies Measured
    By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
  • Competency 1: Analyze relevant health care laws, policies, and regulations; their application; and their effects on organizations, interprofessional teams, and professional practice.
    • Explain the impact of new policy and practice guidelines.
  • Competency 2: Lead the development and implementation of ethical and culturally sensitive policies that improve health outcomes for individuals, organizations, and populations.
    • Justify the importance of a new policy and practice guidelines with regard to improving the quality of care or outcomes related to a selected role group’s work.
    • Determine appropriate and effective instructional content, learning activities, and materials for a training session.
  • Competency 4: Develop strategies to work collaboratively with policy makers, stakeholders, and colleagues to address environmental (governmental and regulatory) forces.
    • Summarize evidence-based strategies for working with a selected role group to promote their buy-in and prepare them to implement a new policy and apply associated practice guidelines to their work.
    • Explain a selected role group’s importance in implementing a new policy and practice guidelines.
  • Competency 5: Produce clear, coherent, and professional written work, in accordance with Capella’s writing standards.
    • Organize content so ideas flow logically with smooth transitions.
    • Support main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.

 

QUESTION 1

1. A 67-year-old Caucasian woman was brought to the clinic by her son who stated that his mother had become slightly confused over the past several days. She had been stumbling at home and had fallen once but was able to ambulate with some difficulty. She had no other obvious problems and had been eating and drinking. The son became concerned when she forgot her son’s name, so he thought he better bring her to the clinic.  
   PMH-Type II diabetes mellitus (DM) with peripheral neuropathy x 20 years. COPD. Depression after death of spouse several months ago 
   Social/family hx – non contributary except for 30 pack/year history tobacco use.  
   Meds: Metformin 500 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago 
   Labs-CBC WNL; Chem 7- Glucose-92 mg/dl, BUN 18 mg/dl, Creatinine 1.1 mg/dl, Na+120 mmol/L, 
   K+4.2 mmol/L, CO237 m mol/L, Cl-97 mmol/L.  
   The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH). 

   Question:
   Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH.

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1 points   

QUESTION 2

1. A 43-year-old female presents to the clinic with a chief complaint of fever, chills, nausea and vomiting and weakness. She has been unable to keep any food, liquids or medications down. The symptoms began 3 days ago and have not responded to ibuprofen, acetaminophen, or Nyquil when she tried to take them. The temperature has reached as high as 102˚F.  

    Allergies: none known to drugs or food or environmental  

    Medications-20 mg prednisone po qd, omeprazole 10 po qam 

    PMH-significant for 20-year history of steroid dependent rheumatoid arthritis (RA). GERD. No other significant illnesses or surgeries. 

   Social-denies alcohol, illicit drugs, vaping, tobacco use 

   Physical exam 

   Thin, ill appearing woman who is sitting in exam room chair as she said she was too weak to climb on the exam table. VS Temp 101.2˚F, BP 98/64, pulse 110, Resp 16, PaO2 96% on room air.  

   ROS negative other than GI symptoms. 

   Based on the patient’s clinical presentation, the APRN diagnoses the patient as having secondary hypocortisolism due to the lack of prednisone the patient was taking for her RA secondary to vomiting.

   Question:

   Explain why the patient exhibited these symptoms? 

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1 points   

QUESTION 3

1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had about of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  
   The APRN examining the patient orders a Chem 7 which revealed a serum Ca++ of 13.1 mg/dl. The APN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 
   Question:
   What is the role of parathyroid hormone in the development of primary hyperparathyroidism? 

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1 points   

QUESTION 4

1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  

   The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 

   Question 1 of 2:

   Explain the processes involved in the formation of renal stones in patients with hyperparathyroidism. 

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0.5 points   

QUESTION 5

1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  
   The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 
   Question 2 of 2:
   Explain how a patient with hyperparathyroidism is at risk for bone fractures.  

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0.5 points   

QUESTION 6

1. A 64-year-old Caucasian female who is 4 weeks status post total parathyroidectomy with forearm gland insertion presents to the general surgeon for her post-operative checkup. She states that her mouth feels numb and she feels “tingly all over. The surgeon suspects the patient has hypoparathyroidism secondary to the parathyroidectomy with delayed vascularization of the implanted gland. She orders a Chem 20 to determine what electrolyte abnormalities may be present. The labs reveal a serum Ca++ of 7.1 mg/dl (normal 8.5 mg/dl-10.5 mg/dl) and phosphorous level of 5.6 mg/dl (normal 2.4-4.1 mg/dl).  

   Question:

   What serious consequences of hypoparathyroidism occur and why? — Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)– Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family —- Font size —Path: pWords:0

1 points   

QUESTION 7

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  

   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  

   Allergies-none know  

   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 

   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 

   Labs in office: random glucose 220 mg/dl.  

   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  

   Question 1 of 6:

   The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polydipsia.”

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1 points   

QUESTION 8

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  

   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  

   Allergies-none know  

   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 

   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 

   Labs in office: random glucose 220 mg/dl.  

   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
   Question 2 of 6:

   The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyuria.”

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1 points   

QUESTION 9

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
   Allergies-none know  
   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
   Labs in office: random glucose 220 mg/dl.  
   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
   Question 3 of 6:
   The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyphagia.”

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1 points   

QUESTION 10

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  

   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  

   Allergies-none know  

   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 

   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 

   Labs in office: random glucose 220 mg/dl.  

   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
   Question 4 of 6:
   The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “weight loss.”

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0.5 points   

QUESTION 11

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
   Allergies-none know  
   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
   Labs in office: random glucose 220 mg/dl.  
   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
   Question 5 of 6:
   The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “fatigue.”

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0.5 points   

QUESTION 12

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
   Allergies-none know  
   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
   Labs in office: random glucose 220 mg/dl.  
   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
   Question 6 of 6:
   How do genetics and environmental factors contribute to the development of Type 1 diabetes?

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1 points   

QUESTION 13

1. A 17-year-old boy recently diagnosed with Type I diabetes is brought to the pediatrician’s office by his parents with a chief complaint of “having the flu”. His symptoms began 2 days ago, and he has vomited several times and has not eaten very much. He can’t remember if he took his prescribed insulin for several days because he felt so sick. Random glucose in the office reveals glucose 560 mg/dl and the pediatrician made arrangements for the patient to be admitted to the hospitalist service with an endocrinology consult.  

   BP 124/80mmHg; HR 122bpm; Respirations 32 breaths/min; Temp 97.2˚F; PaO297% on RA 

   Admission labs: Hgb 14.6 g/dl; Hct 58% 

   CMP- Na+ 122mmol/L; K+ 5.3mmol/L; Glucose 560mg/dl; BUN 52mg/dl; Creatinine 4.9mg/dl;  

   Cl- 95mmol/L; Ca++ 8.8mmol/L; AST (SGOT) 248U/L; ALT 198U/L; CK 34/35 IU/L; Cholesterol 198mg/dl;  

   Phosphorus 6.8mg/dl; Acetone Moderate; LDH38U/L; Alkaline Phosphatase 132U/L. 

   Arterial blood gas values were as follows: pH 7.09; Paco220mm Hg; Po2100mm Hg; Sao2 98% (room air) 

   HCO3-7.5mmol/L; anion gap 19.4 

   A diagnosis of diabetic ketoacidosis was made, and the patient was transferred to the Intensive Care Unit (ICU) for close monitoring.  

   Question:

   The hormones involved in intermediary metabolism, exclusive of insulin, that can participate in the development of diabetic ketoacidosis (DKA) are epinephrine, glucagon, cortisol, growth hormone. Describe how they participate in the development of DKA.

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1 points   

QUESTION 14

1. A 67-year-old African American male presents to the clinic with a chief complaint that he has to “go to the bathroom all the time and I feel really weak.” He states that this has been going on for about 3 days but couldn’t come to the clinic sooner as he went to the Wound Care clinic for a dressing change to his right great toe that has been chronically infected, and he now has osteomyelitis. Patient with known Type II diabetes with poor control. His last HgA1C was 10.2 %. He says he can’t afford the insulin he was prescribed and only takes half of the oral agent he was prescribed. Random glucose in the office revealed glucose of 890 mg/dl. He was immediately referred to the ED by the APRN for evaluation of suspected hyperosmolar hyperglycemic non ketotic syndrome (HHNKS). Also called hyperglycemic hyperosmolar state (HHS).  

   Question:

   Explain the underlying processes that lead to HHNKS or HHS.

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1 points   

QUESTION 15

1. A 32-year-old woman presented to the clinic complaining of weight gain, swelling in her legs and ankles and a puffy face. She also recently developed hypertension and diabetes type 2. She noted poor short-term memory, irritability, excess hair growth (women), red-ruddy face, extra fat around her neck, fatigue, poor concentration, and menstrual irregularity in addition to muscle weakness. Given her physical appearance and history, a tentative diagnosis of hypercortical function was made. Diagnostics included serum and urinary cortisol and serum adrenocorticotropic hormone (ACTH). MRI revealed a pituitary adenoma.  

   Question:

   How would you differentiate Cushing’s disease from Cushing’s syndrome? 

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1 points   

QUESTION 16

1. A 47-year-old female is referred to the endocrinologist for evaluation of her chronically elevated blood pressure, hypokalemia, and hypervolemia. The patient’s hypertension has been refractory to the usual medications such as beta blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors. After a full work up including serum and urinary electrolyte levels, aldosterone suppression test, plasma aldosterone to renin ratio, and MRI which revealed an autonomous adenoma, the endocrinologist diagnoses the patient with primary hyper-aldosteronism.  

   Question:

   What is the pathogenesis of primary hyper-aldosteronism? 

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1 points   

QUESTION 17

1. A 47-year-old African American male presents to the clinic with chief complaints of polyuria, polydipsia, polyphagia, and weight loss. He also said that his vison occasionally blurs and that his feet sometimes feel numb.  He has increased hunger despite weight loss and admits to feeling unusually tired. He also complains of “swelling” and enlargement of his abdomen.  

   Past Medical History (PMH) significant for HTN fairly well controlled with and ACE inhibitor; central obesity, and dyslipidemia treated with a statin, Review of systems negative except for chief complaint. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 290 mg/dl. The APRN diagnoses the patient with type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching. 

   Question:

   What is the basic underlying pathophysiology of Type II DM? 

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1 points   

QUESTION 18

1. A 21-year-old male was involved in a motorcycle accident and sustained a closed head injury. He is waking up and interacting with his family and medical team. He complained of thirst that doesn’t seem to go away no matter how much water he drinks. The nurses note that he has had 3500 cc of pale-yellow urine in the last 24 hours. Urine was sent for osmolality which was reported as 122 mOsm/L. A diagnosis of probable neurogenic diabetes insipidus was made.  

   Question:

   What causes diabetes insipidus (DI)? 

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0.5 points   

QUESTION 19

1. A 43-year-old female patient presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and palpitations. She states she had had the symptoms for several months but attributed the symptoms to beginning to care for her elderly mother who has Alzheimer’s Disease. She has lost 15 pounds in the last 3 months without dieting. Her past medical history is significant for rheumatoid arthritis that she has had for the last 10 years well controlled with methotrexate and prednisone. Physical exam is remarkable for periorbital edema, warm silky feeling skin, and palpable thyroid nodules in both lobes of the thyroid. Pending laboratory diagnostics, the APRN diagnoses the patient as having hyperthyroidism, also called Graves’ Disease.

   Question:

   Explain how the negative feedback loop controls thyroid levels.

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1 points   

QUESTION 20

1. A 43-year-old female patient with known Graves’ Disease presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and severe palpitations. She states she had been given a prescription for propylthiouracil, an antithyroid medication but she did not fill the prescription as she claims she lost it. She had been given the option of thyroidectomy which she declined. She also notes that she is having trouble with her vision and often has blurry eyes. She states that her eyes seem “to bug out of her face”. She has had recurrent outs of nausea and vomiting. She was recently hospitalized for pneumonia.  Physical exam is significant for obvious exophthalmos and pretibial myxedema. Vital signs are temp 101.2˚F, HR 138 and irregular, BP 160/60 mmHg. Respirations 24. Electrocardiogram revealed atrial fibrillation with rapid ventricular response. The APRN recognizes the patient is experiencing symptoms of thyrotoxic crisis, also called thyroid storm. The patient was immediately transported to a hospital for critical care management. 

   Question:

   How did the patient develop thyroid storm? What were the patient factors that lead to the development of thyroid storm? 

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1 points   

QUESTION 21

1. A 44-year-old woman presents to the clinic with complaints of extreme fatigue, weight gain, decreased appetite, cold intolerance, dry skin, hair loss, and sleepiness. She also admits that she often bursts into tears without any reason and has been exceptionally forgetful. Her vision is occasionally blurry, and she admits to being depressed without any social or occupational triggers. Past medical history noncontributory. Physicalexam Temp 96.2˚F, pulse 62 and regular, BP 108/90, respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted. Based on the clinical history and physical exam, and pending laboratory data, the ARNP diagnoses the patient with hypothyroidism.  

   Question:

   What causes hypothyroidism? 

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0.5 points   

QUESTION 22

1. A 44-year-old woman is brought to the clinic by her husband who says his wife has had some mental status changes over the past few days. The patient had been previously diagnosed with hypothyroidism and had been placed on thyroid replacement therapy but had been lost to follow-up due to moving to another city for the husband’s work approximately 4 months ago. The patient states she lost the prescription bottle during the move and didn’t bother to have the prescription filled since she was feeling better. Physical exam revealed non-pitting, boggy edema around her eyes, hands and feet as well as the supraclavicular area. The APRN recognizes this patient had severe myxedema and referred the patient to the hospital for medical management.  

   Question:

   What causes myxedema coma? 

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0.5 points   

QUESTION 23

1. A 53-year-old woman presents to the primary care clinic with complaints of severe headaches, palpitations, high blood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis. 
   Question 1 of 2:

   What is a pheochromocytoma and how does it cause the classic symptoms the patient presented with? 

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0.5 points   

QUESTION 24

1. A 53-year-old woman presents to the primary care clinic with complaints of severe headaches, palpitations, high blood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis. 
   Question 2 of 2:
   What are the treatment goals for managing pheochromocytoma? 

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1 points   

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