I only need 2 questions answered. 3 if you’re feeling generous but I only have the 15 dollars. I need questions 10, and 11 answered. 12 if you’re…

I need help with my lab on HR Diagrams. I only need 2 questions answered. 3 if you’re feeling generous but I only have the 15 dollars. I need questions 10, and 11 answered. 12 if you’re nice. I need this done by 5:30 today. It’s only 2 questions.

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States and describes one way of stopping a totalitarian regime by using political socialization, civil disobedience, resist propaganda. Does not discuss voter apathy.

Required Resources
Read/review the following resources for this activity:
Textbook: Chapter 6, 10
Magstadt, T. M. (2017). Understanding politics: Ideas, institutions, and issues. Australia: Cengage Learning.
Lesson
Instructions
Aristotle defined tyranny as an illegitimate form of government by one individual that tightly controlled every part of life and government. Adolf Hitler is the most notorious tyrant. Using a totalitarian society from the past or present, discuss how the state and its leader attempt to impede citizens from exercising their rights. In your discussion, explain some components of an “ideal citizen,” consequences of voter apathy, and ways the state controls the citizen.
Writing Requirements (APA format)
Length: 1.5-2 pages (not including title page or references page)
1-inch margins
Double spaced
12-point Times New Roman font
Title page
References page (minimum of 2 scholarly sources)
Grading
This activity will be graded based on the essay rubric.
Course Outcomes (CO): 1
Due Date: By 11:59 p.m. MT on Sunday
Rubric
Week 5 Assignment: Essay – Ideal Citizen in a Totalitarian Government
Week 5 Assignment: Essay – Ideal Citizen in a Totalitarian Government
Criteria RatingsPts
This criterion is linked to a Learning Outcome Actual case study of a country.
20.0 pts
Uses a historical or contemporary example of a totalitarian country
16.0 pts
There is a totalitarian country, but it is not real.
12.0 pts
There is a country, but it is not totalitarian.
0.0 pts
There is no country mentioned.
20.0 pts
This criterion is linked to a Learning Outcome Control by a totalitarian leader
20.0 pts
Describes the three ways, violence, propaganda, and scapegoating, that leaders use to keep control in the country.
16.0 pts
Only two of the tactics of totalitarian leaders are described.
12.0 pts
Only one of the tactics of totalitarian leaders are described.
0.0 pts
How a totalitarian leaders keeps control is not addressed.
20.0 pts
This criterion is linked to a Learning Outcome Citizens in the country.
20.0 pts
States and describes two ways of stopping a totalitarian regime by using political socialization, civil disobedience, resist propaganda. Discusses voter apathy.
16.0 pts
States and describes one way of stopping a totalitarian regime by using political socialization, civil disobedience, resist propaganda. Discusses voter apathy.
12.0 pts
States and describes one way of stopping a totalitarian regime by using political socialization, civil disobedience, resist propaganda. Does not discuss voter apathy.
0.0 pts
Does not address the concepts.
20.0 pts
This criterion is linked to a Learning Outcome Scholarly resources
10.0 pts
Uses both the book and, at least, one outside scholarly source.
8.0 pts
Uses only the book or a scholarly source.
6.0 pts
Uses only a scholarly source and the source is not scholarly.
0.0 pts
Does not use the book or scholarly source.
10.0 pts
This criterion is linked to a Learning Outcome APA
5.0 pts
All sources are properly cited and referenced according to APA standards.
4.0 pts
Sources are either properly cited or referenced, missing one of those elements.
3.0 pts
The citation and/or reference are incorrect.
0.0 pts
No APA format was used.
5.0 pts
This criterion is linked to a Learning Outcome Writing
5.0 pts
Presents information using clear and concise language in an organized manner (minimal errors in English grammar, spelling, syntax, and punctuation).
4.0 pts
Presents information using understandable language but is somewhat disorganized (some errors in English grammar, spelling, syntax, and punctuation).
3.0 pts
Presents information using understandable language but is very disorganized (many errors in English grammar, spelling, syntax, and punctuation).
0.0 pts
Presents information that is not clear, logical, professional or organized to the point that the reader has difficulty understanding the message (numerous errors in English grammar, spelling, syntax, and/or punctuation).

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BIS 222 – FINAL EXAM ESSAYS For the final exam, you will be provided four possible essay questions, you will choose THREE to answer. Below are the…

I have to master these questions by Finals on Monday so if anyone can help me I would be very grateful
BIS 222 – FINAL EXAM ESSAYSFor the final exam, you will be provided four possible essay questions, you will choose THREE to answer. Below are thestems for the essay questions – the scaffolded questions will appear on the final exam.Option 1: You work for a pharmaceutical company and are developing a new vaccine to prevent Ebola. Since you are agenius and understand immunology well, you are asked to explain how a vaccine works in detail to the general publicfor a new ad campaign. Identify the sides of the immune system and cells involved and how they "teach" your immunesystem.Option 2: Recently an experiment involving bone marrow transplants from CCR5 mutated (co-receptor on T cells)patients have been used as a method to treat for HIV patients to disrupt infections by allowing HIV binding to CD4which prevents viral fusion and entry. Discuss the rationale behind this experiment.Option 3: Compare and contrast the three lines of defense for the immune system.Option 4: Your patient has been infected by Methicillin-resistant Staphylococcus aureus (MRSA), an extracellularpathogen. Describe the mechanisms for B cell antigen presentation via MHC to T lymphocytes during an adaptiveresponse.Option 5: DiGeorge Syndrome is a genetic condition in which patients are born without a thymus whereas AplasticAnemia is a potential adverse effect from drug toxicity (such as chemotherapy) and radiation poisoning that destroysbone marrow. Both of these result in different immunodeficiencies in patients. Which of these two conditions has thepotential to have the most devastating consequences? Defend your answer.Option 6: The complement cascade is an important contributor to the immune response within the bloodstream. Discussthe role of complement proteins in regard to eliminating pathogens that enter the body, particularly gram-negative bacteria and enveloped viruses.Option 7: Transplantation of tissues and organs have become a common practice in medicine today. Explain the processof transplantation in regards to the immune system and why it is more complex than blood transfusions. Discussthe cells involved and the proteins/surface markers used for communication and recognition. Why would some cells beeasier to transplant than others?ption 8: Superantigens are special types of antigens found in different bacteria which are often toxins and can causetal immune responses such as septic shock. Discuss how superantigens contribute to immune responses and howheir effects differ from normal antigens.tion 9: The Hygiene theory hypothesizes that living in an overly sterile environment may have negative effects on themune system. In contrast, Severe Combined Immunodeficiency (SCID), also known as "bubble boy" syndrome, is aetic condition in which leukocytes are unable to properly develop. Suppose two twins are kept in a completelyrile environment. One twin has a normal immune system, whereas the other has SCID. Discuss how each of thens would react to an allergen like pollen compared to a bacterial infection.

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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?

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

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Linear Acceleration, Force Components (7) Weight, Normal, Friction:

Linear Acceleration, Force Components (7) Weight, Normal, Friction: While working in a mechanical structures laboratory, your boss assigns you to test the strength of ropes under different conditions. Your test set-up consists of two ropes attached to a 30 kg block which slides on a 5.0 m long horizontal table top. Two low friction, light weight pulleys are mounted at opposite ends of the table. One rope is attached to each end of the 30 kg block. Each of these ropes runs horizontally over a different pulley. The other end of one of the ropes is attached to a 12 kg block which hangs straight down. The other end of the second rope is attached to a 20 kg block also hanging straight down. The coefficient of kinetic friction between the block on the table and the table’s surface is 0.08. The 30 kg block is initially held in place by a mechanism that is released when the test begins so, that the block is accelerating during the test. During this test, what is the force exerted on the rope supporting the 12 kg block? (8) Human, Weight, Normal: You are taking care of two small children, Sarah and Rachel, who are twins. On a nice cold, clear day you decide to take them ice skating on Lake of the Isles. To travel across the frozen lake you have Sarah hold your hand and Rachel’s hand. The three of you form a straight line as you skate, and the two children just glide. Sarah must reach up at an angle of 60 degrees to grasp your hand, but she grabs Rachel’s hand horizontally. Since the children are twins, they are the same height and the same weight, 50 lbs. To get started you accelerate at 2.0 m/s2. You are concerned about the force on the children’s arms which might cause shoulder damage. So you calculate the force Sarah exerts on Rachel’s arm, and the force you exert on Sarah’s other arm. You assume that the frictional forces of the ice surface on the skates are negligible. (9). Tension, Weight, Normal, and Friction: You are planning to build a log cabin in northern Minnesota. You will pull the logs up a long, smooth hill to the building site by means of a rope attached to a winch. You need to buy a rope for this purpose, so you need to know how strong the rope must be. Stronger ropes cost more. You know that the logs weigh a maximum of 200 kg. You measure that the hill is at an angle of 30o with respect to the horizontal, and the coefficient of kinetic friction between a log and the hill is 0.90. When pulling a log up the hill, you will make sure that the rope stays parallel to the surface of the hill and the acceleration of the log is never more than 0.80 m/s2. How strong a rope should you buy? (10). Tension, Weight, Normal, Friction: You have taken a summer job at a warehouse and have designed a method to help get heavy packages up a 15° ramp. In your system a package is attached to a rope which runs parallel to the ramp and over a pulley at the top of the ramp. After passing over the pulley the other end of the rope is attached to a counterweight which hangs straight down. In your design the mass of the counterweight is always adjusted to be twice the mass of the package. Your boss is worried about this pulley system. In particular, she is concerned that the package will be too difficult to handle at the top of the ramp and tells you to calculate its acceleration. To determine the influence of friction between the ramp and the package you run some tests. You find that you can push a 50 kg package with a horizontal force of 250 Newtons at a constant speed along a level floor made of the same material as the ramp.

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The primary complication of enterocolitis associated with Hirschsprung disease is related to whic h finding?

Question 1
A 40-year-old female presents complaining of pain near the midline in the epigastrium. Assuming the pain is caused by a stimulus acting on an abdominal organ, the pain felt is classified as:
a. Visceral
b. Somatic
c. Parietal
d. Referred
Question 2
An 8-week-old male was recently diagnosed with cystic fibrosis. Which of the following digestive alterations would be expected?
a. Insufficient bile production
b. Gastric atrophy
c. Hypersecretion of stomach acid
d. Nutrient malabsorption
Question 3
In alcoholic cirrhosis, hepatocellular damage is caused by:
a. acetaldehyde accumulation.
b. bile toxicity.
c. acidosis.
d. fatty infiltrations.
Question 4
Where does the nurse expect the obstruction to be in a patient with extrahepatic portal hypertension?
a. Sinusoids
b. Bile ducts
c. Hepatic portal vein
d. Hepatic artery
Question 5
Kwashiorkor is a severe dietary deficiency of:
a. fat-soluble vitamins.
b. carbohydrates.
c. protein.
d. calcium and magnesium.
Question 6
A 27-year-old male presents with fever, GI bleeding, hepatomegaly, and transient joint pain. He reports that as a child he received blood transfusions following a motor vehicle accident. He also indicates he was vaccinated against hepatitis B. Which of the following types of hepatitis does the clinician think he most likely has?
a. A
b. B
c. C
d. D
Question 7
Prolonged diarrhea is more serious in children than adults because:
a. children have lower adipose reserves.
b. fluid reserves are lower in children.
c. children have a lower metabolic rate.
d. children are more resistant to antimicrobial therapy.
Question 8
A 40-year-old male develops an intestinal obstruction related to protrusion of the intestine through the inguinal ring. This condition is referred to as:
a. Intussusception
b. A volvulus
c. A hernia
d. Adhesions
Question 9
A 60-year-old male presents with GI bleeding and abdominal pain. He reports that he takes NSAIDs daily to prevent heart attack. Tests reveal that he has a peptic ulcer. The most likely cause of this disease is:
a. Increasing subepithelial bicarbonate production
b. Accelerating the H+ (proton) pump in parietal cells
c. Inhibiting mucosal prostaglandin synthesis
d. Stimulating a shunt of mucosal blood flow
Question 10
Acute pancreatitis often manifests with pain to which of the following regions?
a. Right lower quadrant
b. Right upper quadrant
c. Epigastric
d. Suprapubic
Question 11
A 60-year-old male is diagnosed with cancer of the esophagus. Which of the following factors most likely contributed to his disease?
a. Reflux esophagitis
b. Intestinal parasites
c. Ingestion of salty foods
d. Frequent use of antacids
Question 12The primary complication of enterocolitis associated with Hirschsprung disease is related to whic
h finding?
a. Fecal impaction
b. Pancreatic insufficiency
c. Hyperactive peristalsis
d. Ileal atresia
Question 13
The most common cause of chronic vascular insufficiency among the elderly is:
a. Anemia
b. Aneurysm
c. Lack of nutrition in gut lumen
d. Atherosclerosis
Question 14
The most common clinical manifestation of portal hypertension is _____ bleeding.
a. rectal
b. duodenal
c. esophageal
d. intestinal
Question 15
A 54-year-old male is diagnosed with peptic ulcer disease.This condition is most likely caused by:
a. Hereditary hormonal imbalances with high gastrin levels
b. Breaks in the mucosa and presence of corrosive secretions
c. Decreased vagal activity and vascular engorgement
d. Gastric erosions related to high ammonia levels and bile reflux
Question 16
The cardinal sign of pyloric stenosis caused by ulceration or tumors is:
a. Constipation
b. Diarrhea
c. Vomiting
d. Heartburn
Question 17
A 55-year-old male died in a motor vehicle accident. Autopsy revealed an enlarged liver caused by fatty infiltration, testicular atrophy, and mild jaundice secondary to cirrhosis. The most likely cause of his condition is:
a. Bacterial infection
b. Viral infection
c. Alcoholism
d. Drug overdose
Question 18
Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of:
a. hyperbilirubinemia and jaundice.
b. fluid and electrolyte imbalances.
c. impaired ammonia metabolism.
d. decreased cerebral blood flow.
Question 19
The most common disorder associated with upper GI bleeding is:
a. diverticulosis.
b. hemorrhoids.
c. esophageal varices.
d. cancer.
Question 20
A 3-month-old female develops colicky pain, abdominal distention, and diarrhea after drinking cow’s milk. The best explanation for her symptoms is:
a. Deficiency of bile that stimulates digestive secretions and bowel motility
b. Excess of amylase, which increases the breakdown of starch and causes an osmotic diarrhea
c. Overgrowth of bacteria from undigested fat molecules, which leads to gas formation and de creased bowel motility
d. Excess of undigested lactose in her digestive tract, resulting in increased fluid movement into the digestive lumen and increased bowel motility
Question 21
A 55-year-old female has general symptoms of gallstones but is also jaundiced. IV cholangiography would most likely reveal that the gallstones are obstructing the:
a. Intrahepatic bile canaliculi
b. Gallbladder
c. Cystic duct
d. Common bile duct
Question 22
A 1-week-old female is brought to her pediatrician for abdominal distention and unstable temperature. Physical examination reveals bradycardia and apnea. Tests reveal hypoxic injury to the bowel resulting in bacterial invasion and perforation. This condition is referred to as:
a. Infective enteropathy
b. Necrotizing enterocolitis (NEC)
c. Mucoviscidosis
d. Ileus
Question 23
For the patient experiencing esophageal reflux, the nurse would expect which sphincter to be malfunctioning?
a. Pyloric
b. Lower esophageal
c. Upper esophageal
d. Gastric
Question 24
Cholecystitis is inflammation of the gallbladder wall usually caused by:
a. accumulation of bile in the hepatic duct.
b. obstruction of the cystic duct by a gall-stone.
c. accumulation of fat in the wall of the gallbladder.
d. viral infection of the gallbladder.
Question 25
A 6-month-old male infant is brought to the ER after the sudden development of abdominal pain, irritability, and vomiting followed by passing of “currant jelly” stool. Ultrasound reveals intestinal obstruction in which the ileum collapsed through the ileocecal valve and invaginated into the large intestine. This type of obstruction is referred to as:
a. Prolapse
b. Pyloric stenosis
c. Intussusception
d. Imperforation
Question 26
A 22-year-old male underwent brain surgery to remove a tumor. Following surgery, he experienced a peptic ulcer. His ulcer is referred to as a(n) _____ ulcer.
a. Infectious
b. Cushing
c. Ischemic
d. Curling
Question 27
Chronic gastritis is classified according to the:
a. severity.
b. location of lesions.
c. patient’s age.
d. signs and symptoms.
Question 28
Reflux esophagitis is defined as a(n):
a. Immune response to gastroesophageal reflux
b. Inflammatory response to gastroesophageal reflux
c. Congenital anomaly
d. Secretory response to hiatal hernia
Question 29
The cardinal signs of small bowel obstruction are:
a. Vomiting and distention
b. Diarrhea and excessive thirst
c. Dehydration and epigastric pain
d. Abdominal pain and rectal bleeding
Question 30
The nurse assessing the patient with biliary atresia would expect to find which primary clinical manifestation?
a. Anemia
b. Jaundice
c. Hypobilirubinemia
d. Ascites
Question 31
A 20-year-old male was recently diagnosed with lactose intolerance. He eats an ice cream cone and develops diarrhea. His diarrhea can be classified as _____ diarrhea.
a. Motility
b. Hypotonic
c. Secretory
d. Osmotic
Question 32
Which of the following symptoms would help a health care provider distinguish between ulcerative colitis and Crohn disease?
a. Pattern of remission/exacerbations
b. Abdominal pain
c. Malabsorption
d. Diarrhea
Question 33
A 45-year-old male complains of heartburn after eating and difficulty swallowing. He probably has:
a. Pyloric stenosis
b. Hiatal hernia
c. Gastric cancer
d. Achalasia
Question 34
The exocrine portion of the pancreas contains:
a. alpha cells.
b. beta cells.
c. acinar cells.
d. islets of Langerhans.
Question 35
Outbreaks of hepatitis _____ often occur in young children attending day care centers and can be attributed to poor hand washing.
a. A
b. B
c. C
d. D

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An unknown amount of water is mixed with 350 mL of a 6 M solution of NaOH solution. A 75 mL sample of the resulting solution is titrated to…

An unknown amount of water is mixed with 350 mL of a 6 M solution of NaOH solution. A 75 mL sample of the resulting solution is titrated to neutrality with 52 . 5 mL of 6 M HCl. Calculate the concentration of the di- luted NaOH solution. Answer in units of M

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

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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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