Question 1

A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct?
A) Infectious
B) Inflammatory
C) Hematologic
D) Traumatic

Question 2

A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description, which of the following is not a risk factor for melanoma in this patient?
A) Age
B) Hair color
C) Actinic lentigines
D) Heavy sun exposure

Question 3

A 15-year-old high school sophomore and her mother come to your clinic because the mother is concerned about her daughter’s weight. You measure her daughter’s height and weight and obtain a BMI of 19.5 kg/m2. Based on this information, which of the following is appropriate?
A) Refer the patient to a nutritionist and a psychologist because the patient is anorexic.
B) Reassure the mother that this is a normal body weight.
C) Give the patient information about exercise because the patient is obese.
D) Give the patient information concerning reduction of fat and cholesterol in her diet because she is obese.

Question 4

A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months.They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do?
A) Reassure him that there is nothing to worry about.
B) Do laboratory work to check for platelet problems.
C) Obtain an extensive history regarding blood problems and bleeding disorders.
D) Do a skin biopsy in the office.

Question 5

Jacob, a 33-year-old construction worker, complains of a “lump on his back” over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely?
A) An enlarged lymph node
B) A sebaceous cyst
C) An actinic keratosis
D) A malignant lesion

Question 6

A patient comes to you for the appearance of red patches on his forearms that have been present for several months. They remain for several weeks. He denies a history of trauma. Which of the following is likely?
A) Actinic keratoses
B) Pseudoscars
C) Actinic purpura
D) Cherry angiomas

Question 7

A 19-year old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn’t been. Which of the following physical examination descriptions is most consistent with meningitis?
A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of motion
B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle spasm and limited range of motion to the right
C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion
D) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full range of motion

Question 8

A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be “stuck on” and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis?
A) Actinic keratosis
B) Seborrheic keratosis
C) Basal cell carcinoma
D) Squamous cell carcinoma

Question 9

A patient presents for evaluation of a cough. Which of the following anatomic regions can be responsible for a cough?
A) Ophthalmologic
B) Auditory
C) Cardiac
D) Endocrine

Question 10

A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing loss. He has noticed some decreased ability to hear what his wife and grandchildren are saying to him. He admits to lip-reading more. He has a history of noise exposure in his young adult years: He worked as a sound engineer at a local arena and had to attend a lot of concerts. Based on this information, what is the most likely finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds

Question 11

Mrs.Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash?
A) Insect bites
B) Urticaria, or hives
C) Psoriasis
D) Purpura

Question 12

A new mother is concerned that her child occasionally “turns blue.” On further questioning, she mentions that this is at her hands and feet. She does not remember the child’s lips turning blue. She is otherwise eating and growing well. What would you do now?
A) Reassure her that this is normal
B) Obtain an echocardiogram to check for structural heart disease and consult cardiology
C) Admit the child to the hospital for further observation
D) Question the validity of her story

Question 13

An 89-year-old retired school principal comes for an annual check-up. She would like to know whether or not she should undergo a screening colonoscopy. She has never done this before. Which of the following factors should not be considered when discussing whether she should go for this screening test?
A) Life expectancy
B) Time interval until benefit from screening accrues
C) Patient preference
D) Current age of patient

Question 14

You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?
A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution
B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution
D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution

Question 15

A 79-year-old retired banker comes to your office for evaluation of difficulty with urination; he gets up five to six times per night to urinate and has to go at least that often in the daytime. He does not feel as if his bladder empties completely; the strength of the urinary stream is diminished. He denies dysuria or hematuria. This problem has been present for several years but has worsened over the last 8 months. You palpate his prostate. What is your expected physical examination finding, based on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy

Question 16

A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small “pits” in his nails. What would account for these findings?
A) Eczema
B) Pityriasis rosea
C) Psoriasis
D) Tinea infection

Question 17

A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which is the most likely pathologic process?
A) Infection
B) Inflammation
C) Allergic
D) Vascular

Question 18

A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs.Based on this description, what is your most likely diagnosis?
A) Actinic keratosis
B) Seborrheic keratosis
C) Basal cell carcinoma
D) Squamous cell carcinoma

Question 19

An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling or inflammation. There are no hair shafts visible. Based on this description, what is your most likely diagnosis?
A) Alopecia areata
B) Trichotillomania
C) Tinea capitis
D) Traction alopecia

Question 20

A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis?
A) Pityriasis rosea
B) Tinea versicolor
C) Psoriasis
D) Atopic eczema

Question 21

Which of the following booster immunizations is recommended in the older adult population?
A) Tetanus
B) Diphtheria
C) Measles
D) Mumps

Question 22

A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine

Question 23

Ms.Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do?
A) Conclude that these are lesions she has had for a long time.
B) Wait for her to mention them before asking further questions.
C) Ask how she acquired them.
D) Conduct the visit as usual for the patient.

Question 24

You have recently returned from a medical missions trip to sub-Saharan Africa, where you learned a great deal about malaria. You decide to use some of the same questions and maneuvers in your “routine” when examining patients in the midwestern United States. You are disappointed to find that despite getting some positive answers and findings, on further workup, none of your patients has malaria except one, who recently emigrated from Ghana. How should you next approach these questions and maneuvers?
A) Continue asking these questions in a more selective way.
B) Stop asking these questions, because they are low yield.
C) Question the validity of the questions.
D) Ask these questions of all your patients.

Question 25

On routine screening you notice that the cup-to-disc ratio of the patient’s right eye is 1:2. What ocular condition should you suspect?
A) Macular degeneration
B) Diabetic retinopathy
C) Hypertensive retinopathy
D) Glaucoma

Question 26

Mrs.Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn’t blanch. What would you tell her regarding her rash?
A) It is likely to be related to her lupus.
B) It is likely to be related to an exposure to a chemical.
C) It is likely to be related to an allergic reaction.
D) It should not cause any problems.

Question 27

A 47-year-old contractor presents for evaluation of neck pain, which has been intermittent for several years. He normally takes over-the-counter medications to ease the pain, but this time they haven’t worked as well and he still has discomfort. He recently wallpapered the entire second floor in his house, which caused him great discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic process?
A) Infectious
B) Neoplastic
C) Degenerative
D) Traumatic

Question 28

A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis?
A) Pityriasis rosea
B) Tinea versicolor
C) Psoriasis
D) Atopic eczema

Question 29

Which of the following changes are expected in vision as part of the normal aging process?
A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision

Question 30

You are examining an unconscious patient from another region and notice Beau’s lines, a transverse groove across all of her nails, about 1 cm from the proximal nail fold. What would you do next?
A) Conclude this is caused by a cultural practice.
B) Conclude this finding is most likely secondary to trauma.
C) Look for information from family and records regarding any problems which occurred 3 months ago.
D) Ask about dietary intake.

In a complex and fast-paced healthcare environment, change is inevitable and constant. The advanced practice nurse is required to lead and adapt to the constant changing environment while working with multidisciplinary teams. Imagine you are assigned by your director to work with a multidisciplinary team that is assisting with transition from the current paper record-based system to an electronic health record (EHR).

Create a PowerPoint presentation (10-15 slides) in which you will assess the situation and the steps that should be taken to successfully implement the change. Be sure to include 100-250 word presenter’s notes per slide. Your presentation should address the following:

1. Describe the driving forces that relate to the need for implementing electronic health records.
2. Identify the key interprofessional stakeholders (both internal and external) that should be involved in change efforts.
3. Outline how you would initiate the change and be a change advocate. Utilizing change theory and innovative models of care, explain how you would provide a structure for the planned change to achieve successful implementation of the EHR.
4. Demonstrate how the change will affect current workflows. What revised workflow would you implement?
5. Identify resources (human, time, material, etc.) required for implementation.
6. Identify risks within the implementation plan. What are the impacts of the poor planning on cost, quality, and safety?
7. Identify potential barriers when implementing the change and discuss how you will handle resistance.

Integrate 3-5 scholarly sources into your presentation.

Before posting to the discussion board, locate one research article or EBP guideline that relates to this week’s topics

Locate a current research article (within the last 5 years) or EBP guideline which addresses physiologic or sensory issues within the aged, disabled, or chronically ill populations. Then address the following:

Entitle your discussion post with the title of the article/guideline

Provide a rationale for why you’ve chosen this article/guideline and state how you intend to use it in practice in one paragraph.

Apply one of the BSN Core Competencies that fit the article/guideline & state your rationale for using it.

Attach the full research article or EBP guideline as a document in the discussion board so that other students can read them and respond more effectively.

 

The State Board of Nursing for Texas determines the scope of practice for nursing in this state.  The American Nurses’ Association (ANA)provide guidelines for nursing performance. “The Texas Nursing Practice Act (NPA) defines the legal scope of practice for professional registered nurses (RNs)” (“Texas Board of Nursing – Practice – Registered Nurse Scope of Practice,” n.d.). 

There is a six-step decision making model for determining the scope of practice this is determined by the State Board of Nursing. 

I currently work in Management at a long-term care facility. There are ethical standards that I have to abide by. This includes following by the State Facility Human Resource Manual with all personnel issues/concerns. I must maintain confidentiality within my unit and with each employee. It is very important to be prudent in my knowledge and wisdom, dealing with different nurses. As an RN, I must follow the Nurse Practice Act and maintain my practice within my scope. 

Please read the instructions and answer the questions. Be aware that it is master level, APA format 6 edit, more than 3 updated references. 

Much of the ongoing debate over scope-of-practice (SoP) laws that govern the practice of nurse practitioners (NPs) across the country focuses on the cost of and access to health care and on whether these laws legitimately promote patient safety or are simply anticompetitive restrictions on NPs’ ability to compete with physicians. After completing the following CE activity at Medscape https://www.medscape.org/viewarticle/506277_1 (sign for the free account), please answer the following questions:

Should an NP who is educationally prepared as an acute care NP work in an adult primary care setting? 

Is it within the scope for an FNP to diagnose and treat uncomplicated mental health conditions like depression, anxiety, and ADHD?

Are there any restrictions for the FNP to treat patients with mood disorders and to prescribe them antipsychotics or SSRIs?