You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur?

Question
Question 1. You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism?
Moist and smooth
Moist and rough
Dry and smooth
Dry and rough
Question 2. Question : You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or noninflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process?
Tenderness
Cool temperature
Ecchymosis
Nodules
Question 3. Question : 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?
Actinic keratosis
Seborrheic keratosis
Basal cell carcinoma
Squamous cell carcinoma
Question 4. Question : A 28-year-old graduate student comes to your clinic for evaluation of pain “all over.” With further questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints. She states that the pain is worse in the morning. There is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation. Muscle strength and range of motion are normal. Which one of the following is likely the cause of her pain?
Rheumatoid arthritis
Osteoarthritis
Fibromyalgia
Polymyalgia rheumatica
Question 5. Question : Heberden’s nodes are commonly found in which one of the following diseases?
Rheumatoid arthritis
Degenerative joint disease
Psoriatic arthritis
Septic arthritis
Question 6. Question : A new patient is complaining of severe pruritus that is worse at night. Several family members also have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and on the axillae. This finding is most consistent with:
Contact dermatitis
Impetigo
Larva migrans
Scabies
Question 7. Question : An obese 55-year-old woman went through menarche at age 16 and menopause 2 years ago. She is concerned because an aunt had severe osteoporosis. Which one of the following is a risk factor for osteoporosis?
Obesity
Late menopause
Having an aunt with osteoporosis
Delayed menarche
Question 8. Question : Ms. Whiting is a 68-year-old female 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?
Conclude that these are lesions she has had for a long time.
Wait for her to mention them before asking further questions.
Ask how she acquired them.
Conduct the visit as usual for the patient.
Question 9. Question : A 58-year-old man comes to your office complaining of bilateral back pain that now awakens him at night. This has been steadily increasing for the past 2 months. Which one of the following is the most reassuring in this patient with back pain?
: Age over 50
Pain at night
Pain lasting more than 1 month or not responding to therapy
Pain that is bilateral
Question 10. Question : The Phalen’s test is used to evaluate:
Inflammation of the median nerve
Rheumatoid arthritis
Degenerative joint changes
Chronic tenosynovitis
1. Question : Which of the following would lead you to suspect a hydrocele versus other causes of scrotal swelling?
The presence of bowel sounds in the scrotum
Being unable to palpate superior to the mass
A positive transillumination test
Normal thickness of the skin of the scrotum
Question 2. Question : You are examining a newborn and note that the right testicle is not in the scrotum. What should you do next?
Refer to urology
Recheck in six months
Tell the parent the testicle is absent but that this should not affect fertility
Attempt to bring down the testis from the inguinal canal
Question 3. Question : A 50-year-old truck driver comes to your clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system complaints. His past medical history is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different trucking company. He smokes one pack of cigarettes a day, drinks less than six beers a week, and denies using any illegal drugs. His mother has high blood pressure and arthritis and his father died of lung cancer in his sixties. On examination, his blood pressure is 130/80 and his pulse is 80. His cardiac, lung, and abdominal examinations are normal. He has no inguinal hernia, but on his digital rectal examination you palpate a soft, smooth, and nontender pedunculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation?
Internal hemorrhoid
Prostate cancer
Anorectal cancer
Rectal polyp
Question 4. Question : A 15-year-old high school football player is brought to your office by his mother. He is complaining of severe testicular pain since exactly 8:00 this morning. He denies any sexual activity and states that he hurts so bad he can’t even urinate. He is nauseated and is throwing up. He denies any recent illness or fever. His past medical history is unremarkable. He denies any tobacco, alcohol, or drug use. His parents are both in good health. On examination, you see a young teenager lying on the bed with an emesis basin. He is very uncomfortable and keeps shifting his position. His blood pressure is 150/100, his pulse is 110, and his respirations are 24. On visualization of the penis, he is circumcised and there are no lesions and no discharge from the meatus. His scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the patient begins to cry. His prostate examination is unremarkable. His cremasteric reflex is absent on the left but is normal on the right. By catheter you get a urine sample and the analysis is unremarkable. You send the boy with his mother to the emergency room for further workup.
Acute orchitis
Acute epididymitis
Torsion of the spermatic cord
Prostatitis
Question 5. Question : Which is true of prostate cancer?
It is commonly lethal.
It is one of the less common forms of cancer.
Family history does not appear to be a risk factor.
Ethnicity is a risk factor.
Question 6. Question : Which of the following conditions involves a tight prepuce which, once retracted, cannot be returned?
Phimosis
Paraphimosis
Balanitis
Balanoposthitis
Question 7. Question : A 12-year-old is brought to your clinic by his father. He was taught in his health class at school to do monthly testicular self-examinations. Yesterday, when he felt his left testicle, it was enlarged and tender. He isn’t sure if he has had burning with urination and he says he has never had sexual intercourse. He has had a sore throat, cough, and runny nose for the last three days. His past medical history is significant for a tonsillectomy as a small child. His father has high blood pressure and his mother is healthy. On examination, you see a child in no acute distress. His temperature is 100.8 and his blood pressure and pulse are unremarkable. On visualization of his penis, he is uncircumcised and has no lesions or discharge. His scrotum is red and tense on the left and normal appearing on the right. Palpating his left testicle reveals a mildly sore swollen testicle. The right testicle is unremarkable. An examining finger is put through both inguinal rings, and there are no bulges with bearing down. His prostate examination is unremarkable. Urine analysis is also unremarkable. What abnormality of the testes does this child most likely have?
Acute orchitis
Acute epididymitis
Torsion of the spermatic cord
Prostatitis
Question 8. Question : The most common cause of cancer deaths in males is:
Lung cancer
Prostate cancer
Colon cancer
Skin cancer
Question 9. Question : Important techniques in performing the rectal examination include which of the following?
Lubrication
Waiting for the sphincter to relax
Explaining what the patient should expect with each step before it occurs
All of the above
Question 10. Question : Jim is a 47-year-old man who is having difficulties with sexual function. He is recently separated from his wife of 20 years. He notes that he has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem?
Decreased testosterone levels
Psychological issues
Abnormal hypogastric arterial circulation
Impaired neural innervation
Question 1. Which of the following is true of human papilloma virus (HPV) infection?
Pap smear is a relatively ineffective screening method.
It commonly resolves spontaneously in one to two years.
It is the second most common STI in the United States.
HPV infections cause a small but important number of cervical cancers.
Question 2. Question : Which of the following is the most effective pattern of palpation for breast cancer?
Beginning at the nipple, make an ever-enlarging spiral.
Divide the breast into quadrants and inspect each systematically.
Examine in lines resembling the back and forth pattern of mowing a lawn.
Beginning at the nipple, palpate vertically in a stripe pattern.
Question 3. Question : A 14-year-old junior high school student is brought in by his mother and father because he seems to be developing breasts. The mother is upset because she read on the Internet that smoking marijuana leads to breast enlargement in males. The young man adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is unremarkable. His parents are both in good health. He has two older brothers who never had this problem. On examination, you see a mildly overweight teenager with enlarged breast tissue that is slightly tender on both sides. Otherwise, his examination is normal. He is agreeable to taking a drug test. What is the most likely cause of his gynecomastia?
Breast cancer
Imbalance of hormones of puberty
Drug use
Question 4. Question : Which of the following represents metrorrhagia?
Fewer than 21 days between menses
Excessive flow
Infrequent bleeding
Bleeding between periods
Question 5. Question : What does a KOH (potassium hydroxide) prep help the nurse practitioner diagnose?
Herpes zoster infections
Yeast infections
Herpes simplex infections
Viral infections
Question 6. Question : Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true?
This is most likely due to lack of lubrication.
This is most likely due to atrophic vaginitis.
This is most likely due to pressure on an ovary.
Psychosocial reasons may cause this condition.
Question 7. Question : A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no diagnosis of breast cancer in his first-degree relatives. What is the most likely diagnosis?
Breast tissue
Fibrocystic disease
Breast cancer
Lymph node
Question 8. Question : Which of the following is true regarding breast self-examination?
It has been shown to reduce mortality from breast cancer.
It is recommended unanimously by organizations making screening recommendations.
A high proportion of breast masses are detected by breast self-examination.
The undue fear caused by finding a mass justifies omitting instruction in breast self-examination.
Question 9. Question : A 23-year-old computer programmer comes to your office for an annual examination. She has recently become sexually active and wants to be placed on birth control. Her only complaint is that the skin in her armpits has become darker. She states it looks like dirt, and she scrubs her skin nightly with soap and water but the color stays. Her past medical symptoms consist of acne and mild obesity. Her periods have been irregular for 3 years. Her mother has type 2 diabetes, and her father has high blood pressure. The patient denies using tobacco but has four to five drinks on Friday and Saturday nights. She denies any illegal drug use. On examination, you see a mildly obese female who is breathing comfortably. Her vital signs are unremarkable. Looking under her axilla, you see dark, velvet-like skin. Her annual examination is otherwise unremarkable. What disorder of the breast or axilla is she most likely to have?
Peau d’orange
Acanthosis nigricans
Hidradenitis suppurativa
Question 10. Question : Which of the following is true of women who have had a unilateral mastectomy?
They no longer require breast examination.
They should be examined carefully along the surgical scar for masses.
Lymphedema of the ipsilateral arm usually suggests recurrence of breast cancer.
Women with breast reconstruction over their mastectomy site no longer require examination.
Question 1. A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about three days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, three days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over fifty years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination, he appears his stated age and is in no acute distress. His temperature is 100.9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative.His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending.
What diagnosis for abdominal pain best describes his symptoms and signs?
Acute diverticulitis
Acute cholecystitis
Acute appendicitis
Mesenteric ischemia
Question 2. Question : Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for two days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?
Bleeding from a diverticulum
Bleeding from a peptic ulcer
Bleeding from a colon cancer
Bleeding from cholecystitis
Question 3. Question : A 26-year-old sports store manager comes to your clinic, complaining of severe right-sided abdominal pain for twelve hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was the night before and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination, he appears ill and is lying on his right side. His temperature is 100.4 degrees and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one-third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant (RLQ). His rectal, inguinal, prostate, penile, and testicular examinations are normal.
What is the most likely cause of his pain?
Acute appendicitis
Acute mechanical intestinal obstruction
Acute cholecystitis
Mesenteric ischemia
Question 4. Question : Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?
His spleen is definitely enlarged and further workup is warranted.
His spleen is possibly enlarged and close attention should be paid to further examination.
His spleen is possibly enlarged and further workup is warranted.
His spleen is definitely normal.
Question 5. Question : Diminished radial pulses may be seen in patients with which of the following?
Aortic insufficiency
Hyperthyroidism
Arterial emboli
Early “warm” septic shock
Question 6. Question : A 42-year-old florist comes to your office, complaining of chronic constipation for the last six months. She has had no nausea, vomiting, or diarrhea, and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems (ROS), you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination, she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons.
What is the best choice for the cause of her constipation?
Large bowel obstruction
Irritable bowel syndrome
Rectal cancer
Hypothyroidism
Question 7. Question : A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of sixteen, but is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?
Intermittent claudication
Chest pressure with exertion
Shortness of breath
Knee pain
Question 8. Question : You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient’s pain make you concerned for this disease process?
Thigh
Knee
Calf
Ankle
Question 9. Question : A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms?
Femoral pulse, popliteal pulse
Dorsalis pedis pulse, posterior tibial pulse
Carotid pulse
Radial pulse, brachial pulse
Question 10. Question : Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant (LUQ) pain. On examination of this area, a rough grating noise is heard. What is this sound?
It is a splenic rub.
It is a variant of bowel noise.
It represents borborygmi.
It is a vascular noise.
Question 1.A 30-year-old woman with a history of mitral valve problems states that she has been “very tired.” She has started waking up at night and feels like her “heart is pounding.” During the assessment, the nurse practitioner palpates a thrill and lift at the fifth left intercostal space midclavicular line. In the same area the nurse practitioner also auscultates a blowing, swishing sound right after S1. These findings would be most consistent with:
heart failure.
aortic stenosis.
pulmonary edema.
mitral regurgitation.
Question 2. Question : A patient presents with excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that lasts about 1/2 to 2 hours, occurring once or twice each day. The nurse practitioner suspects:
hypertension.
cluster headaches.
tension headaches.
migraine headaches.
Question 3. Question : A patient complains that while studying for an examination he began to notice a severe headache in the frontotemporal area of his head that is throbbing and is somewhat relieved when he lies down. He tells the nurse practitioner that his mother also had these headaches. The nurse practitioner suspects that he may be suffering from:
hypertension.
cluster headaches.
tension headaches.
migraine headaches.
Question 4. Question : A patient tells the nurse practitioner that he is very nervous, that he is nauseated, and that he “feels hot.” This type of data would be:
objective.
reflective.
subjective.
introspective
Question 5. Question : The most important reason to share information and offer brief teaching while performing the physical examination is to help:
the examiner feel more comfortable and gain control of the situation.
build rapport and increase the patient’s confidence in the examiner.
the patient understand his or her disease process and treatment modalities.
the patient identify questions about his or her disease and potential areas of patient education.
Question 6. Question : A patient says that she has recently noticed a lump in the front of her neck below her “Adam’s apple” that seems to be getting bigger. During the assessment, the finding that reassures the nurse practitioner that this may not be a cancerous thyroid nodule is that the lump (nodule):
is tender.
is mobile and not hard.
disappears when the patient smiles.
is hard and fixed to the surrounding structures.
Question 7. Question : A patient visits the clinic because he has recently noticed that the left side of his mouth is paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse practitioner suspects that he has:
Cushing’s syndrome.
Parkinson’s syndrome.
Bell’s palsy.
had a cerebrovascular accident (stroke).
Question 8. Question : The temporomandibular joint is just below the temporal artery and anterior to the:
hyoid.
vagus.
tragus.
mandible.
Question 9. Question : During an examination of a patient’s abdomen, the nurse practitioner notes that the abdomen is rounded and firm to the touch. During percussion, the nurse practitioner notes a drum-like quality of the sound across the quadrants. This type of sound indicates:
constipation.
air-filled areas.
the presence of a tumor.
the presence of dense organs.
Question 10. Question : A patient tells the nurse that he is allergic to penicillin. What would be the nurse practitioner’s best response to this information?
“Are you allergic to any other drugs?”
“How often have you received penicillin?”
“I’ll write your allergy on your chart so you won’t receive any.”
“Please describe what happens to you when you take penicillin.”
Question 11. Question : A patient’s thyroid is enlarged, and the nurse practitioner is preparing to auscultate the thyroid for the presence of a bruit. A bruit is a:
low gurgling sound best heard with the diaphragm of the stethoscope.
loud, whooshing, blowing sound best heard with the bell of the stethoscope.
soft, whooshing, pulsatile sound best heard with the bell of the stethoscope.
high-pitched tinkling sound best heard with the diaphragm of the stethoscope.
Question 12. Question : After completing an initial assessment on a patient, the nurse practitioner has documented that his respirations are eupneic and his pulse is 58. This type of data would be:
objective.
reflective.
subjective.
introspective.
Question 13. Question : A patient tells the nurse that she has had abdominal pain for the past week. What would be the best response by the nurse?
“Can you point to where it hurts?”
“We’ll talk more about that later in the interview.”
“What have you had to eat in the last 24 hours?”
“Have you ever had any surgeries on your abdomen?”
Question 14. Question : A teenage patient comes to the emergency department with complaints of an inability to “breathe and a sharp pain in my left chest.” The assessment findings include the following: cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. This description is consistent with:
bronchitis.
a pneumothorax.
acute pneumonia.
an asthmatic attack.
Question 15. Question : The inspection phase of the physical assessment:
yields little information.
takes time and reveals a surprising amount of information.
may be somewhat uncomfortable for the expert practitioner.
requires a quick glance at the patient’s body systems before proceeding on with palpation.
Question 16. Question : The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. What would be an appropriate response by the nurse practitioner?
“It is unusual for a small child to have frequent ear infections unless there is something else wrong.”
“We need to check the immune system of your son to see why he is having so many ear infections.”
“Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear.”
“Your son’s eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily.”
Question 17. Question : The nurse practitioner would use bimanual palpation technique in which situation?
Palpating the thorax of an infant
Palpating the kidneys and uterus
Assessing pulsations and vibrations
Assessing the presence of tenderness and pain
Question 18. Question : The patient’s record, laboratory studies, objective data, and subjective data combine to form the:
database.
admitting data.
financial statement.
discharge summary.
Question 19. Question : When preparing to perform a physical examination on an infant, the examiner should:
have the parent remove all clothing except the diaper on a boy.
instruct the parent to feed the infant immediately before the exam.
encourage the infant to suck on a pacifier during the abdominal exam.
ask the parent to briefly leave the room when assessing the infant’s vital signs.
Question 20. Question : The nurse practitioner notices that an infant has a large, soft lump on the side of his head and that his mother is very concerned. She tells the nurse practitioner that she noticed the lump about 8 hours after her baby’s birth, and that it seems to be getting bigger. One possible explanation for this is:
hydrocephalus.
craniosynostosis.
cephalhematoma.
caput succedaneum.
Question 21. Question : When examining an infant, the nurse practitioner should examine which area first?
Ear
Nose
Throat
Abdomen
Question 22. Question : When preparing to examine a 6-year-old child, which action is most appropriate?
Start with the thorax, abdomen, and genitalia before examining the head.
Avoid talking about the equipment being used because it may increase the child’s anxiety.
Keep in mind that a child this age will have a sense of modesty.
Have the child undress from the waist up.
Question 23. Question : The nurse practitioner is assessing a patient’s skin during an office visit. What is the best technique to use to best assess the patient’s skin temperature?
Use the fingertips because they’re more sensitive to small changes in temperature.
Use the dorsal surface of the hand because the skin is thinner than on the palms.
Use the ulnar portion of the hand because there is increased blood supply that enhances temperature sensitivity.
Use the palmar surface of the hand because it is most sensitive to temperature variations because of increased nerve supply in this area.
Question 24. Question : Percussion notes heard during the abdominal assessment may include:
flatness, resonance, and dullness.
resonance, dullness, and tympany.
tympany, hyperresonance, and dullness.
resonance, hyperresonance, and flatness.
Question 25. Question : The nurse practitioner is assessing a patient for possible peptic ulcer disease and knows that which condition often causes this problem?
Hypertension
Streptococcus infections
History of constipation and frequent laxative use
Frequent use of nonsteroidal anti-inflammatory drugs
Question 1: You are participating in a health fair and performing cholesterol screens. One person has a cholesterol level of 225. She is concerned about her risk for developing heart disease. Which of the following factors is used to estimate the 10-year risk of developing coronary heart disease?
Ethnicity
Alcohol intake
Gender
Asthma
Question 2. Question : You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur?
Upright
Upright, but leaning forward
Supine
Left lateral decubitus
Question 3. Question : You are screening people at the mall as part of a health fair. The first person who comes for screening has a blood pressure of 132/85. How would you categorize this?
Normal
Prehypertension
Stage 1 hypertension
Stage 2 hypertension
Question 4. Question : How should you determine whether a murmur is systolic or diastolic?
Palpate the carotid pulse.
Palpate the radial pulse.
Judge the relative length of systole and diastole by auscultation.
Correlate the murmur with a bedside heart monitor.
Question 5. Question : A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an electrocardiogram (ECG) because of her history of hypertension. You diagnose a previous myocardial infarction and ask her if she had any symptoms related to this.Which of the following symptoms would be more common in this patient’s age group for an AMI?
Chest pain
Syncope
Pain radiating into the left arm
Pain radiating into the jaw
Question 6. Question : On examination, you find a bounding carotid pulse on a 62-year-old patient. Which murmur should you suspect?
Mitral valve prolapse
Pulmonic stenosis
Tricuspid insufficiency
Aortic insufficiency
Question 7. Question : Which of the following correlates with a sustained, high-amplitude point of maximal impulse (PMI)?
Hyperthyroidism
Anemia
Fever
Hypertension
Question 8. Question : A 68-year-old woman with hypertension and diabetes is seen by the nurse practitioner for a dry cough that worsens at night when she lies in bed. She has shortness of breath, which worsens when she exerts herself. The patient’s pulse rate is 90/min and regular. The patient has gained 6 lbs over the past two months. She is on a nitroglycerine patch and furosemide daily. The explanation for her symptoms is:
Kidney failure
Congestive heart failure
Angiotensin-converting enzyme (ACE) inhibitor induced coughing
Thyroid disease
Question 9. Question : When listening to a soft murmur or bruit, which of the following may be necessary?
Asking the patient to hold their breath.
Asking the patient in the next bed to turn down the TV.
Checking your stethoscope for air leaks.
All of the above.
Question 10. Question : You notice a patient has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely?
Emphysema
Asthma exacerbation
Severe left heart failure
Cardiac tamponade
Question 1. Question : A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these?
Asthma
COPD
Bronchiectasis
Heart failure
Question 2. Question : A sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer.She denies any recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex.
Pneumonia
COPD
Pleural pain
Left-sided heart failure
Question 3. Question : A patient with long-standing COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next?
Percuss the lower border of the liver.
Measure the span of the liver.
Order a hepatitis panel.
Obtain an ultrasound of the liver.
Question 4. Question : A fifty-five-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should be considered because of her gesture?
Bronchitis
Costochondritis
Pericarditis
Angina pectoris
Question 5. Question : When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?
Bronchitis
Simple asthma
Cystic fibrosis
Heart failure
Question 6. Question : Is the following information subjective or objective? Mr. Mazz has shortness of breath that has persisted for the past ten days; it is worse with activity and relieved by rest.
Subjective
Objective
Question 7. Question : All of the following are implicated in causing chronic cough except:
Chronic bronchitis
Allergic rhinitis
Acute viral upper respiratory infection
Gastroesophageal reflux disease
Question 8. Question : A mother brings her infant to you because of a “rattle” in his chest with breathing. Which of the following would you hear if there is a problem in the upper airway?
Different sounds from the nose and the chest
Asymmetric sounds
Inspiratory sounds
Sounds louder in the lower chest
Question 9. Question : Which of the following is consistent with good percussion technique?
Allow all of the fingers to touch the chest while performing percussion.
Maintain a stiff wrist and hand.
Leave the plexor finger on the pleximeter after each strike.
Strike the pleximeter over the distal interphalangeal join

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Rank the following, with 1 being highest or most: (2 points each) N a. Boiling Point OH b. Reactivity toward NaOH (SN2) Br Br c. Reactivity toward…

hey can you help me solve these following questions.
2. Rank the following, with 1 being highest or most: (2 points each)Na. Boiling PointOHb. Reactivity toward NaOH (SN2)BrBrc. Reactivity toward H2SO4/heat (elimination reaction)OHOHOHd. AcidityCH3CO2HNH3CH4H203. Trimethylamine [(CH3)3N] is a molecule in which the nitrogen atom ishybridizedand the CNC bond angle is(3 pt)4. Choose the correct hybridization for the atom indicated in the molecule below. (2 pt)HH" C = C = C -H5. The two resonance structures for CH2N2 (no overall charge) are shown below, but the locationof lone pairs and formal charges (required for both structures) are not specified. (4 pt)a) Draw in lone pairs where needed (such that the overall charge really is zero!).b) Specify formal chargesc) Circle the resonance structure that would make the larger contribution to the overall hybrid.HHHC = N=NHC-NEN

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A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are NOT active in the development of her breasts?

Question 2.
A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are NOT active in the development of her breasts?
Prolactin
Oxytocin
Estrogen
Follicle-stimulating hormone
Progesterone
Question 4.
A 51-year-old woman who has been receiving estrogen and progesterone therapy (EPT) for the last 5 years has visited her care provider because her peers have told her about the risks of heart disease, stroke, and breast cancer that could accompany hormone therapy (HT). How should her care provider respond to her concerns?
“There is a demonstrable increase in breast cancer risk with HT, but the risk of stroke or heart disease actually goes down slightly.”
“All things considered, the benefits of HT outweigh the slightly increased risks of heart disease, stroke, or breast cancer.”
“HT is actually associated with a decrease in heart disease risk, but there is an increase in stroke risk; the breast cancer connection is still unclear.”
“There’s in fact a slight protective effect against stroke associated with HT, but this is partially offset by increased rates of heart disease and breast cancer.”
Question 5.
After a long and frustrating course of constant vaginal pain, a 38-year-old woman has been diagnosed with generalized vulvodynia by her nurse practitioner. What treatment plan is her nurse practitioner most likely to propose?
Alternative herbal therapies coupled with antifungal medications
Antidepressant and antiepileptic medications
Lifestyle modifications aimed at accommodating and managing neuropathic pain
Narcotic analgesia and nonsteroidal anti-inflammatory medications
Question 6.
Which of the following situations would be considered pathologic in an otherwise healthy 30-year-old female?
The woman’s ovaries are not producing new ova.
The woman’s ovaries do not synthesize or secrete luteinizing hormone (LH).
The epithelium covering the woman’s ovaries is broken during the time of ovulation.
The woman’s ovaries are not producing progesterone
Question 9.
A 24-year-old woman has presented to an inner-city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman’s most likely treatment and prognosis?
Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy.
Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease.
Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection.
Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism.
Question 13.
A 71-year-old man has visited his nurse practitioner for a check-up, during which the nurse practitioner has initiated a discussion about the patient’s sexual function. Which of the following phenomena would the nurse practitioner most likely consider a pathological rather than an age-related change?
The presence of relative or absolute hypogonadism
A decrease in the size and firmness of the patient’s testes
Cessation of FSH production
A decrease in the force of the man’s ejaculation
Question 15.
A 57-year-old woman who has been diagnosed with atrophic vaginitis has expressed her surprise to her care provider, citing a lifetime largely free of gynecological health problems. She has asked what may have contributed to her problem. How can the care provider best respond?
“The lower levels of estrogen since you’ve begun menopause make your vagina prone to infection.”
“Vaginitis is not usually the direct result of any single problem, but rather an inevitability of the vaginal dryness that accompanies menopause.”
“This type of vaginitis is most commonly a symptom of a latent sexually transmitted infection that you may have contracted in the distant past.”
“The exact cause of this problem isn’t known, but it can usually be resolved with a diet high in probiotic bacteria.”
Question 17.
A 29-year-old woman has been trying for many months to become pregnant, and fertilization has just occurred following her most recent ovulation. What process will now occur that will differentiate this ovulatory cycle from those prior?
Human chorionic gonadotropin will be produced, preventing luteal regression.
The remaining primary follicles will provide hormonal support for the first 3 months of pregnancy.
The corpus luteum will atrophy and be replaced by corpus albicans.
The basal layer of the endometrium will be sloughed in preparation for implantation.
Question 21.
A 20-year-old male has been diagnosed with a chlamydial infection, and his primary care provider is performing teaching in an effort to prevent the patient from infecting others in the future. Which of the following statements by the patient demonstrates the best understanding of his health problem?
“Either me or a partner could end up with an eye infection from chlamydia that could make us blind.”
“Even though I couldn’t end up sterile, a woman that I give it to certainly could.”
“Each of the three stages of the disease seems to be worse than the previous one.”
“Even if I spread it to someone else, there’s a good chance she won’t have any symptoms or know she has it.”
Question 25.
A 40-year-old male patient with multiple health problems has been diagnosed with a testosterone deficiency. Which of the following assessment findings would his care provider attribute to an etiology other than this deficiency?
The patient has a voice that is unusually high in pitch.
The patient has long-standing anemia and low red cell counts.
The patient has a history of susceptibility to upper respiratory infections.
The patient has a low muscle mass as a proportion of total body weight.
Question 27.
A 66-year-old man has presented to a nurse practitioner to get a refill for his antiplatelet medication. The patient has a history of ischemic heart disease and suffered a myocardial infarction 5 years ago and has unstable angina; he uses a transdermal nitroglycerin patch to control his angina. The patient has a 40-pack-year smoking history and uses nebulized bronchodilators at home for the treatment of transient shortness of breath. He has long-standing hypertension that is treated with a potassium-sparing diuretic and a ß-adrenergic blocking medication. During the nurse’s assessment, the man notes that he has been unable to maintain his erection in recent months. Which of the following aspects of the man’s health problems and treatments would the nurse identify as NOT being contributing to his erectile dysfunction (ED)?
His antihypertensive medications
His use of bronchodilators
His hypertension
His ischemic heart disease
His smoking history
His age
Question 28.
Which of the following statements best captures an aspect of normal spermatogenesis?
Testosterone chemically lyses each primary spermatocyte into two secondary spermatocytes with 23 chromosomes each.
Sertoli cells differentiate into spermatids, each of which can contribute half of the chromosomes necessary for reproduction.
Spermatogonia adjacent to the tubular wall undergo meiotic division and provide a continuous source of new germinal cells.
Each primary spermatocyte undergoes two nuclear divisions, yielding four cells with 23 chromosomes each.
Question 29.
A 39-year-old male patient has been recently diagnosed with primary hypogonadism. Which of the following lab results would be most indicative of this diagnosis?
Normal levels of free testosterone; low levels of total testosterone
Low free testosterone, LH, and FSH levels
Low levels of GnRH
Low testosterone levels; normal levels of LH and FSH

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Provide Mechanisms for the Following Transformations. (3 points each) (Note: in some of these mechanisms, either the reactant or the product may not…

When dealing with organic II trying to provide mechanisms for the following synthesis any explanation especially with the electron movement would be greatly appreciated
69. Provide Mechanisms for the Following Transformations. (3 points each) (Note: in someof these mechanisms, either the reactant or the product may not be a "final product" or an"isolable chemical". But you should still be able to write the mechanisms.)1. LDA (LiNR2)Ph2.a.BrPhNaOCH3OHPhCH3OH Phb.OH OH+OHHOH H2OC.OHiNaOMeOOPhOCH3MeOHPhOCH3d.PhOCH3 H*OHOH20+ CH3OH(Note: This process iscentral to the metabolismof carbohydrates)C.OH+Hf.NMe2H,O

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How are your two comparison groups different, as they are currently stated the groups seem very much the same, could you state, standard care instead of pre and post intervention assessments?

10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project
Week Two Assignment Instructions DNP 820
Please read the instructions thoroughly there are strict requirements
I need at least 10 different articles/literature reviews added to the ones in the 815 attachment. I have also included the chart to be filled out All within 5 years and pertinent to the subject.
Tutor MUST have a good command of the English language
The Rubric must be followed, and all the requirements met
This is a thorough professor, and she has strict requirements
I have attached the PICOT and the first 10 points (DNP 815) assignment. This is a continuation of that assignment. Please read the attachments
The following needs to be addressed:
Please note the followings: The introduction and the literature review are complete and thorough. The problem statement is written clearly PICOT is clear and very good Sample:
· How will you determine the sample size?
· What are the inclusion/exclusion criteria of the subjects? Methodology: Why is the selected methodology is appropriate? Please justify!
· Data collection approach needs to be clear. How will you collect your data? What is needed here is to describe the process of collecting data form signing the informed consent until completing the measuring.
· Data analysis-What test will you use to answer your research question?
Clinical/PICOT Questions:
“In adult patients with CVC at a Clear Lake Regional Medical Center, does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to standard care over a one-month period?”
P: Patients with Central Venous Catheters
I: Staff re-education related to Hygiene of the hub
C: Other hospitals
O: Reduce probability of CLABSIs
T: Two months
“In Patients > 65 years of age with central line catheters at a Clear Lake Regional Medical Center, how does staff training of key personnel and reinforcement of central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) over a one-month period?”
P: Patients > 65 years of age with a Central line
I: Staff training and reinforcement of Central Catheter, Hub Hygiene
C: Other area hospitals
O: Reduce probability of CLABSIs
“In adult patients, with define CVC (CVC), does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to pre and post-intervention assessments
1. I used central Missouri as an example, replace with a description of your site.
2. While you might be interested in CLASBI rates as a primary variable, there are other patient outcomes that would also be important to consider
3. Ensure you can find validity and reliability measures on CLASBI rates if you cannot, we need to determine another question to help
4. How are your two comparison groups different, as they are currently stated the groups seem very much the same, could you state, standard care instead of pre and post intervention assessments?
5. One month is the longest time you can use for a prospective project
Please note the following regarding the instructors grading
IMPORTANT INFORMATION ABOUT MY GRADING STYLE
As you prepare for written papers and manuscripts I’d like to give you some details about my grading style. I provide significant feedback on your papers, this is because I believe you should be working towards improving your writing so that at the end of this program you are able to successfully write your DPI project. In order to write well, you need feedback and you need to review that feedback and make progress on the next written work. To that end I always grade accordingly. This means that if I provide feedback one an item (for example APA format of your reference page) I expect that this will be improved on the next written submission. Otherwise I will deduct additional points. In addition, some other criteria to get down pat now. References should always
1. Be current, no older than 5 years that means 5 years from your proposed graduation date (2014-2019). Otherwise you will have to redo everything in DNP 955.
2. Be primary sources. You can no longer cite Young declared literary war in 1956 (as cited by Brown 2006). You must cite Young 1956. That means go find that paper and read it and make sure that you agree with what Brown said. What if you don’t agree due to some very valid points? Then the literary war is not what occurred, but instead you have concerns regarding point ____, ____, and ____.
3. You may no longer cite textbooks, they are 1) secondary sources and 2) not current enough, and please use peer reviewed manuscripts.
One more item that is not a reference. You may not use direct quotes any longer. There is no need. This may be difficult at first, but you are moving towards a different type of writing. This is manuscript writing (scientific writing). Scientific writing is terse, clear, and concise. No frilly words. In order to avoid the use of direct quotes you will synthesize the literature. There is a great resource for synthesizing the literature under Resources – Add-ons. These are also some other great writing resources there.
Details:
In the prospectus, proposal, and scholarly project there are 10 strategic points that need to be clear, simple, correct, and aligned to ensure the research is doable, valuable, and credible. The 10 strategic points emerge from researching literature on a topic that is based on or aligned with the learner’s personal passion, future career purpose, and degree area. These 10 points provide a guiding vision for DPI Project. In this assignment, you will continue the work begun in DNP-815, working on your draft of a document addressing the 10 key strategic points that define your intended research focus and approach.
General Requirements:
Use the following information to ensure successful completion of the assignment:
Locate the “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” that you completed in DNP-815.
Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please Review the rubric prior to the beginning to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
Directions:
Use the “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” resource to draft statements for each of the 10 points for your intended research study.
You worked on this last in DNP 815. Pick up from where you left off (if you transferred in and did not complete this, you will have to begin fresh). Please include a copy of your last instructor feedback when you submit this assignment. You can either copy and paste the instructor feedback into your current paper (as an appendix and clearly marked); or upload two separate papers. I expect significant improvement from your last submission.
Please review the 10 Strategic Points document for additional instructions and an example. Add references to this document, I suggest 5-10 at this point. You need to realize that your literature review chapter will need at least 50+ articles by the time you get to DNP 955, so work on expanding your literature search each week, to include more and more to this paper as you move through each course. If you cannot locate 50+ articles you can ask your faculty for assistance or chose a different topic.
For the methodology and design sections. Methodology should cover the broad methods you plan to use (qualitative, quantitative, or mixed methods). The design portion will then go into more detail and discuss the design (i.e. correlational, cross-sectional, pre/posttest, etc.). Describe each and explain why your chosen methodology and design are appropriate to your topic and project questions. You may NOT use qualitative, GCU leadership does not support a qualitative methodology.
Intervention. You must have an intervention that you implement. Since you cannot evaluate a project that has already been implemented, please write up a description of your intervention and what your role will be in implementing this intervention. This is not a section listed on your 10 Strategic Points document as of yet, so add it after the methodology and design sections. Describe step by step what the intervention consists of, how it is evidence based, how you will implement, and your role in implementation.
Data collection should go step by step (extremely over-detailed) on how you will collect the data. Tell me about all instruments, surveys, and/or questions you will ask of participants. One MUST be a valid and reliable tool.
Data Analysis. Tell me the specific statistics you will use. Start with descriptive statistics, which ones will you use, why (cite current primary sources). Then tell me how you will compare your data (which statistic), what your p value will be before you start your data collection

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An airplane propeller consists of three radial blades, each of length 1.8 m and mass 20 kg. The propeller rotates at 2500 rev/min.

An airplane propeller consists of three radial blades, each of length 1.8 m and mass 20 kg. The propeller rotates at 2500 rev/min. If the airplane is flying around a curve of radius 500 m at a speed of 360 km/h, what is the rate of change of angular momentum of the propeller? What torque is required to change the angular momentum at this rate? Draw a diagram showing L, dL/dt, and torque.

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If a dye had a molar absorptivity coefficient of 5,000 M-1cm-1, which cuvette pathlength would best to measure the absorbance of the dye when testing…

If a dye had a molar absorptivity coefficient of 5,000 M-1cm-1, which cuvette pathlength would best to measure the absorbance of the dye when testing it in the range of 1.00 – 20.0 µM? Choose from (i) 0.50 cm, (ii) 1.0 cm, or (iii) 3.0 cm. Explain your reasoning by describing why each one would or would not be suitable.

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What details did the patient provide regarding her personal and medical history?

Gynecologic Health
Select a patient that you examined as a nurse practitioner student during the last three weeks of clinical on OB/GYN Issue. With this patient in mind, address the following in a SOAP Note 1 OR 2 PAGES :
Subjective: What details did the patient provide regarding her personal and medical history?
Objective: What observations did you make during the physical assessment?
Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters for this patient , as well as a rationale for this treatment and management plan.
Very Important: Reflection notes: What would you do differently in a similar patient evaluation?
Reference
Gagan, M. J. (2009). The SOAP format enhances communication. Kai Tiaki Nursing New Zealand, 15(5), 15.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.
Chapter 6, “Care of the Well Woman Across the Life Span” ,“Care of the Woman Interested in Barrier Methods of Birth Control” (pp. 275–278)
Chapter 7, “Care of the Woman with Reproductive Health Problems”
“Care of the Woman with Dysmenorrhea” (pp. 366–368)
“Care of the Woman with Premenstrual Symptoms, Syndrome (PMS), or Dysphoric Disorder (PMDD)” (pp. 414–418)

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9 . The ABO blood groups in humans is a multiple- allelic condition that exhibits co- dominance , The /{ and 18 alleles* are responsible for type A

Use punnete squares to complete the following problems:
9 .The ABO blood groups in humans is a multiple- allelic condition that exhibits co- dominance , The /{ and 18 alleles*are responsible for type A and B blood cells respectively . The i allele is responsible for type O cells . If a motherwho is I’i mates with a father who is 1 3; , what are the possible genotypes and phenotypes of their offspring ?Incomplete Dominance10 . Snapdragon flowers exhibit incomplete dominance patterns with regard to flower color . There are two allelesfor the flower color gene , one ( R ) for red flowers , and one ( W ) for white flowers ; heterozygous are pink . What isthe probability of getting a plant with pink flowers by crossing a plant with white flowers to a plant with pinkflowers ?"

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Describe MacKinnon’s “dominance” approach to gender politics. Does thinking in terms of power rather than difference change the nature of the debate?

1. Pateman says the sexual contract is part of the social contract. Describe with reference to the “Founding Fathers” of the U.S.; and the establishment of Australia.
2. How, for Pateman, does the liberal idea of individual rights mask patriarchy and curtail the political lives of women?
3. Is there a politics to sex, relations between the sexes, and private life? Is the sex industry political?
4. MacKinnon says that whether one focuses on sameness or difference, man remains the measure of all things (p. 382). How does this work?
5. Why does MacKinnon consider American society “an affirmative action plan” for men (p.384).
6. What are the fallacies of thinking in terms of “women’s” art, culture, morality, or history (sometimes called “her-story)?
7. Describe MacKinnon’s “dominance” approach to gender politics. Does thinking in terms of power rather than difference change the nature of the debate?
Directions:
Answers MUST come from the book “Introduction to Political Theory” by Bronner. Please state the question first and then the answer. The answer must be 5-6 sentences long.

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