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rheumatoid arthritis.

Question

Week 6 quiz

Question 1

A 65-year-old woman has an advanced form of rheumatoid arthritis. Her treatment includes a regular dosage of methotrexate. The nurse will advise her to take which of the following vitamin supplements while taking the drug?

A) Vitamin A
B) Vitamin B
C) Vitamin C
D) Vitamin D

Question 2

To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic patient, as the patient regains consciousness, the nurse should

A) administer calcium supplements.
B) position the patient in the side-lying position.
C) administer carbohydrates.
D) monitor for nausea and vomiting.

Question 3

A female patient with a diagnosis of type 1 diabetes mellitus has been experiencing increasing neuropathic pain in recent months, a symptom that has not responded appreciably to conventional analgesics. The patient’s care provider has begun treatment with gabapentin (Neurontin). How is the addition of this drug likely to influence the management of the patient’s existing drug regimen?

A) The patient may be required to temporarily hold her other medications until a stable serum level of gabapentin is achieved.
B) It is unlikely to influence the patient’s other medications because gabapentin does not interact with other drugs.
C) Gabapentin is contraindicated with the use of exogenous insulin.
D) The patient’s medication-related risk for renal failure must be assessed prior to the use of gabapentin.

Question 4

A nurse is caring for a patient who has been diagnosed with hypothyroidism. Levothyroxine (Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for which of the following?

A) History of taking anticoagulant drugs
B) Allergy to seafood
C) Hirsutism
D) The patient’s age

Question 5

A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor which of the following?

A) Prothrombin time and partial thromboplastin time
B) Urine specific gravity
C) Alanine aminotransferase and total bilirubin levels
D) Follicle-stimulating hormone levels

Question 6

A nurse is assessing a patient who has come to the emergency department complaining of back spasms. The patient states that he has a history of opioid addiction and does not want to take any drug that “puts me at risk of becoming physically dependent.” Which of the following medications would the nurse question, if ordered?

A) Methocarbamol (Robaxin)
B) Orphenadrine (Norflex)
C) Cyclobenzaprine (Flexeril)
D) Metaxalone (Skelaxin)

Question 7

A 40-year-old woman with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize when updating the nursing care plan for this patient?

A) Risk for Injury related to CNS depressant effects
B) Diarrhea related to anticholinergic effects
C) Altered Nutrition, Less than Body Requirements, related to appetite suppression
D) Impaired Swallowing related to increased muscle tone

Question 8

A nurse is working with a 57-year-old man who is a former intravenous drug abuser. He has been prescribed a weekly dosage of methotrexate for his rheumatoid arthritis. Which of the following will the nurse include in her teaching plan for this patient?

A) Avoid high-fat foods
B) Drink plenty of water every day
C) Take the tablets before bedtime
D) Avoid red meat

Question 9

Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine?

A) The resident has not eaten breakfast because of a recent loss of appetite
B) The resident’s apical heart rate is 112 beats/minute with a regular rhythm
C) The resident had a fall during the night while transferring from her bed to her bathroom
D) The resident received her annual influenza vaccination the previous day

Question 10

A nurse is caring for a 61-year-old man who has had a severe attack of gout while in the hospital for food poisoning. The nurse administers colchicine intravenously in order to

A) avoid aggravating the gastrointestinal tract.
B) ensure quick distribution of the drug.
C) prevent the risk of infection or bleeding.
D) minimize the risk of depressed bone marrow function.

Question 11

A patient receives 25 units of NPH insulin at 7.AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction?

A) After breakfast
B) Before lunch
C) Late afternoon
D) Bedtime

Question 12

A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient’s

A) blood pressure.
B) potassium level.
C) use of alcohol.
D) use of salt in his diet.

Question 13

A male patient with a diagnosis of relapsing-remitting multiple sclerosis is in the clinic to discuss with the nurse the possibility of self-administration of glatiramer. During the patient education session for self-administration, the nurse will emphasize

A) the need to rotate the injection site of the drug.
B) the need to avoid crushing the tablet.
C) the need to place the tablet under the tongue.
D) the need to use only the thigh muscle for the drug injection site.

Question 14

A diabetic patient being treated for obesity tells the nurse that he is having adverse effects from his drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which of the following adverse effects would need the nurse’s immediate attention?

A) Decreased libido
B) Increased blood glucose
C) Dry eyes
D) Jittery feeling

Question 15

A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an expectorant). What special instructions should the nurse include in the patient teaching for this situation?

A) Wash hands before and after taking the medicine
B) Keep track of any gastrointestinal tract infections
C) Monitor glucose levels closely
D) Note the time the medicine is taken each day

Question 16

A 13-year-old patient has juvenile arthritis. He has recently had oral surgery and was told by the surgeon to take aspirin for the pain. The nurse will monitor for which of the following?

A) Bronchoconstriction
B) Hepatotoxicity
C) Aplastic anemia
D) Agranulocytosis

Question 17

A nurse has been invited to speak to a support group for persons with movement disorders and their families. Which of the following statements by the nurse addresses the chronic nature of these diseases and the relevant drug therapies?

A) “Drug therapy can consist of one or more drugs to eliminate the symptoms of these diseases.”
B) “Drugs do not cure these disorders; they instead enhance quality of life.”
C) “Persons of all cultures are treated similarly and respond in similar ways to treatment.”
D) “Drugs used to treat these disorders always pose a risk of severe liver and kidney dysfunction.”

Question 18

A patient in need of myocardial infarction prophylaxis has been prescribed sulfinpyrazone for gout. Which of the following will the nurse monitor the patient most closely for?

A) Hypothermia
B) Hypotension
C) Renal dysfunction
D) Bleeding

Question 19

A nurse is developing a care plan for a patient who has multiple sclerosis. An expected outcome for the patient who is receiving glatiramer would be a decrease in

A) chest pain.
B) fatigue.
C) breathing difficulties.
D) heart palpitations.

Question 20

A 32-year-old female patient is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the patient and her husband that the adverse effect that poses the greatest safety risk to the patient is

A) constipation.
B) dry mouth.
C) fatigue.
D) hypotension.

Question 21

A 34-year-old male patient is prescribed methimazole (MMI).The nurse will advise him to report which of the following immediately?

A) Vertigo
B) Intolerance to cold
C) Loss of appetite
D) Epigastric distress

Question 22

A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium).In light of this new addition to her drug regimen, what teaching point should the woman’s nurse provide?

A) “This will likely relieve your muscle spasms but you’ll probably develop a certain amount of dependence on the drug over time.”
B) “We’ll need to closely monitor your blood sugar levels for the next week.”
C) “There’s a small risk that you might experience some hallucinations in the first few days that you begin taking this drug.”
D) “You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity.”

Question 23

A patient with type 1 diabetes has been admitted to the hospital for orthopedic surgery and the care team anticipates some disruptions to the patient’s blood glucose levels in the days following surgery. Which of the following insulin regimens is most likely to achieve adequate glycemic control?

A) Small doses of long-acting insulin administered four to five times daily
B) Doses of basal insulin twice daily with regular insulin before each meal
C) Large doses of rapid-acting insulin combined with long-acting insulin each morning and evening
D) Divided doses of intermediate-acting insulin every 2 hours, around the clock

Question 24

During long-term desmopressin therapy in a 48-year-old woman, it will be most important for the nurse to assess which of the following?

A) The patient’s environment
B) The patient’s diet
C) The condition of the patient’s skin
D) The condition of the patient’s nasal passages

Question 25

A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to

A) crush the tablet before swallowing.
B) swallow the tablet whole.
C) swallow the tablet with milk or food.
D) avoid drinking milk for 3 hours after swallowing the tablet.

Question 26

A nurse will instruct a patient taking allopurinol to take each dose

A) at night.
B) first thing in the morning.
C) after a meal.
D) before a meal.

Question 27

The nurse is conducting a medication reconciliation of a new resident of a long-term care facility. The nurse notes that the resident takes allopurinol on a daily basis for the treatment of gout. What is the primary purpose of this drug?

A) To balance urate concentration and prevent gout attacks
B) To promote the remodeling of damaged synovium
C) To potentiate the metabolism of dietary purines
D) To achieve pain relief in joints affected by gout

Question 28

A nurse is teaching a patient about his newly prescribed drug, colchicine, for gout. The nurse will instruct the patient to avoid which of the following foods?

A) Green beans
B) Shrimp
C) Eggs
D) Milk

Question 29

A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which of the following instructions?

A) Eat a high-protein diet
B) Decrease the dosage if any adverse effect is experienced
C) Wear appropriate clothing and sunscreen whenever he is in direct sunlight
D) Have a complete blood cell count done weekly

Question 30

A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When developing a care plan for this patient, which factor will be most important for the nurse to consider?

A) Dietary habits
B) Work environment
C) Typical daily fluid intake
D) Ethnicity

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mental health facilities

My community is Bakersfield, California I was thinking of interviewing in regards to lack of mental health facilities and planning locally.

 

This is a Collaborative Learning Community assignment.

This assignment consists of both an interview and a PowerPoint (PPT) presentation.

Assessment/Interview

Select a community of interest. It is important that the community selected be one in which a CLC group member currently resides. Students residing in the chosen community should be assigned to perform the physical assessment of the community.

  1. Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
  2. Interview a community health and public health provider regarding that person’s role and experiences within the community.

Interview Guidelines

Interviews can take place in-person, by phone, or by Skype. Complete the “Provider Interview Acknowledgement Form” and submit with the group presentation.

Develop one set of interview questions to gather information about the role of the provider in the community and the health issues faced by the chosen community.

Compile key findings from the interview, including the interview questions used, and submit with the group presentation.

 

APA format is required for essays only. Solid academic writing is always expected. For all assignment delivery options, documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

When submitting this assignment, include the interview questions, the interview findings, completed “Provider Interview Acknowledgement Form,” and the community assessment PPT presentation.

 

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20 Anus,Rectum,Prostate 

Chapter: 20 Anus,Rectum,Prostate 

While you are examining a 1-year-old girl, the mother mentions how eager she is to begin toilet training her child. How should you respond? When is it best to begin toilet training?

What do the rectum and anus form?

Control of the external anal sphincter is gradually achieved at what age?

Differentiate between internal and external hemorrhoids.

You are observing an examiner take the history of a 70-year-old man as part of the musculoskeletal examination. You notice that the examiner asks the patient about exercise habits in his early years. Is this a relevant question to ask this patient? Why or why not?

A young woman is concerned about a 1-cm difference in the length of her legs. What is the best response to give this patient?

A 3-year-old boy has had anal itching that becomes worse at night. What do these symptoms indicate?

You are assessing a pregnant woman who has had a fourth-degree perineal laceration. Why is it necessary to assess this patient’s anal sphincter function?

You are about to perform a rectal examination of an older adult. What is the suggested position for this patient?

What is a clue to the diagnosis of Hirschsprung disease?

What do persistent, pencil-like stools suggest?

Distinguish between the stool of a formula-fed baby and a breastfed baby.

Create a chart or two-column list that compares the risk factors for colorectal cancer with those for prostatic cancer.

What are the risk factors for colorectal cancer?

What are the risk factors for prostate cancer?

What symptoms are associated with BPH?

JF is a 42-year-old patient who presents for an annual examination, but he complains that he has had a fever for the past few days and recently some “urinary symptoms.”

1- Describe the best method for a rectal examination during the physical assessment

2- What additional past medical history questions would you ask of JF since you suspect prostatitis?

3- During the rectal examination of JF with acute prostatitis, what findings would expect on physical examination? .

A, Correct procedure for introducing finger into rectum. Press pad of finger against the anal opening. B, As external sphincter relaxes, slip the fingertip into the anal canal. Note that patient is in the hips-flexed position.

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LGBTQ

  1. Discuss aspects of a health concern not being addressed (LGBTQ issues) despite the efforts of services and partnerships involved and describe the ultimate outcome(s) or goal(s) from Healthy People 2020 relating to that specific health concern.

Answering the following questions may assist in data interpretation:

  • What similarities are apparent between the data that were gathered and the data that were generated?
  • What differences are apparent between the data that were gathered and the data that were generated?
  • What are the weakness and strengths of this community?
  • In what areas is improvement needed in this community?

The assignment should be written in an APA-formatted essay. The essay should be between 1500 and 2000 words in length and include at least two scholarly sources other than provided materials.

(this is the link for healthy people 2020     https://www.healthypeople.gov/2020/topics-objectives

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Physician Assisted Suicide

My assignment is to submit a rough draft about a medical ethics issue. For my topic I have chosen Physician Assisted Suicide, I will attach the outline I turned in, which that is what you will be using.  The paper is for you to revise, as well as add an additional page.  Below I will attach the rubric as well as my outline.

This assignment will be turned in to turnitin.com so please refrain from any plagiarism.

This is to be done APA style, Pence, G. E. (2017). Medical ethics: Accounts of ground-breaking cases. New York, NY: McGraw Hill Education MUST BE USED AS A REFERENCE, as well as another credible source.

These were my professors notes therefore please adjust the paper accordingly:

It seems that your main topic is a discussion of Physician-Assisted Suicide.  You do not need to include as much information about active and passive euthanasia.  You might make a brief statement initially about how PAS is different from active and passive euthanasia.  But then focus on the topic of PAS.

Please remember to identify and discuss the relevant ethical theories and bioethical principles for the pro and the con arguments for PAS.

Include the U.S. Supreme Court ruling that determined if PAS is a constitutionally protected right across thew U.S and also identified what level of government has the authority to determine if PAS is legal or illegal.  This is a different Supreme Court ruling from the one that determined that the right to discontinue or refuse treatment (passive euthanasia) is a constitutionally protected right across all states in the U.S., so be sure to differentiate these two cases and the rulings.

Also, the official positions of the AMA and the ANA are relevant to the discussion.

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cardiac murmur

NUR6550 Final Exam

1. The Valsalva maneuver and the squat-to-stand maneuver are likely to increase the sound of a cardiac murmur associated with which of these conditions?

2. Which of the following conditions may result in lower extremity edema?

Nephrotic syndrome

Decompensated congestive heart failure

Cirrhosis

Renal failure

Deep venous thrombosis

Late-stage pregnancy

All of the above

3. Art Bakke is a 46-year-old male who is being treated for an acute myocardial infarction. He has now developed significant dyspnea at rest and, per physical exam, has coarse rales involving the lower 2/3 of the lung fields bilaterally. You suspect acute pulmonary edema due to papillary-muscle rupture and acute mitral-valve regurgitation.

Question: Which of the following physical findings would support this diagnostic hypothesis?

A palpable diastolic murmur maximal in the second intercostal space (ICS) at the left sternal border

A harsh, rumbling, diastolic murmur heard maximally in the fourth ICS at the left sternal border

A holosystolic systolic murmur heard maximally in the fifth ICS at the midclavicular line

4. The most common ECG finding in a patient with a cardiomyopathy is an ST-elevation MI.

True

False

5. Nina Martinez is a 70-year-old female who experienced an episode of acute pulmonary edema following an endovascular aneurysm repair. She was discharged on furosemide 60 mg daily and instructed to follow up with cardiology. She is now seen in the office at 2 weeks post discharge. Her metabolic panel includes the following lab values:

·          Na 126 mEq/L

·          K 4.0 mEq/L

·          Cl 93 mEq/L

·          CO2 28 mEq/L

·          BUN 40 mg/dL

·          Cr 1.3 mg/dL

Question: This patient has which of the following abnormalities as a likely consequence of diuretic overuse?

Hyponatremia

Hypokalemia

Metabolic acidosis

6. Which of the following are primary cardiomyopathy categories, as described by the World Health Organization (WHO) in 1995?

Dilated cardiomyopathy

Symbol Hypertrophic cardiomyopathy (HCM)

Symbol Restrictive cardiomyopathy

Symbol Arrhythmogenic right ventricular dysplasia

Symbol Unclassified

All of the above

7. What is the most common cause of sudden cardiac death in young people?

What is the most common cause of sudden cardiac death in young people?

Myocardial infarction

Hypertrophic cardiomyopathy

Supraventricular tachycardia

Arrhythmogenic right ventricular dysplasia; aka arrhythmogenic right ventricular cardiomyopathy (ARVC)

8. Which of the following are treatment options for a patient who presents with peripartum cardiomyopathy while still carrying the fetus? (Select all that apply.)

ACE inhibitors

Induction if stable

Emergent cesarean section if unstable

Digoxin

Nitroglycerin

9. What are the 3 major clinical complications related to cardiomyopathies?

Arrhythmias; including ventricular tachycardia and ventricular fibrillation

Thromboembolic complications; including DVT, PE, and ventricular thrombi

Acute pulmonary edema

10. Some patients with primary cardiomyopathies remain asymptomatic throughout their lifetime.

True

False

11. A 38-year -old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports earlier in the day she was feeling a migraine starting so she took a pill given to her by her friend who also experiences migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did she most likely take?

Acetaminophen and caffeine (Excedrin ® Migraine)

Naproxen sodium (Aleve ® )

Almotriptan (Axert ® )

Butalbital, acetaminophen and caffeine (Fioricet ® )

12. You are seeing a 68-year-old woman for treatment of an uncomplicated urinary tract infection (UTI). She has well-controlled hypertension, type 2 diabetes mellitus, and dyslipidemia and takes an angiotensin-converting enzyme inhibitor (ACEI), statin, biguanide, and low-dose aspirin (ASA). She worked in a dry cleaning facility until approximately 8 years ago. During her evaluation, she mentions that she sometimes has difficulty understanding conversation, especially in noisy environments. This is likely a:

Drug-related reaction.

Consequence of occupational chemical exposure.

Early sign of dementia.

Normal age-related change in hearing

13. While evaluating a 33-year-old female with a 2-day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection (UTI) caused by a Gram-negative organism?

Nitrites

30 mg/dL protein

Epithelial cells

pH>8

14. All of the following are examples of primary prevention strategies except:

Counseling an elderly patient prior to discharge about fall risk at home and how to prevent falls through adequate illumination.

Performing a hemoglobin A1C for all patients admitted to the hospital.

Conducting a study to identify the leading cause of mortality in teenagers and how to reduce risk.

Immunizing all adults ?60 years with zoster vaccine.

15. A 23-year-old woman is being evaluated for an upper respiratory tract infection. As you prepare for auscultation, the patient states “I have a benign murmur that has been with me my whole life”. Anticipating a physiologic murmur, you would expect which of the following characteristics?

Usually obliterates S2.

Becomes softer when going from a supine to standing position.

Occurs late in systole.

Has localized area of auscultation

16. You see a 73-year-old woman with a 40 pack- year smoking history, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) who presents with an ulcer on the sole of her left foot. The ulcer has an irregular edge and pale base and a punched out appearance, with the surrounding skin white and shiny. The patient states that the pain is worse at night in bed and when the legs are elevated. The most likely diagnosis is:

Pressure ulcer

Pyoderma gangrenosum

Venous ulcer

Arterial ulcer

17. You see a 76-year-old woman living at home who is accompanied by her home care provider. She has COPD and type 2 diabetes mellitus. An example of a secondary prevention strategy is:

Administering the seasonal influenza vaccine.

Screening for physical or financial abuse/Checking her blood glucose level.

Checking her blood pressure.

Adjusting her insulin dosing regimen.

18. A 43-year-old woman is being evaluated in the emergency department with a complaint of a severe headache. She describes a unilateral, pulsing headache that was preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm. The patient stated she noticed a “funny smell” prior to the symptoms starting. This description is most typical of:

Migraine with aura.

Cluster headache.

Transient ischemic attack.

Tension-type headache.

19. You see a 54-year-old man living in subsidized housing with a history of hypertension. He states that he stopped taking his blood pressure medication about 4 months ago because of costs. He is concerned because his blood pressure is high whenever he checks it, though he does not report any symptoms. His BP at this visit is 196/104 mm Hg. Upon examination of this patient, you would expect to detect an S 4 sound heard during:

Early systole.

Late systole.

Early diastole.

Late diastole.

20. 32-year-old man requires evaluation for hepatitis infection prior to taking a job as a restaurant cook. He presents with the following laboratory results:

Hepatitis A Panel Hepatitis B Panel Hepatitis C Panel

Anti-HAV Negative HBsAg Negative Anti-HCV Positive

IgM Negative Anti-HBc Negative HCV RNA Negative

IgM NegativeAnti-HBs Positive

You recognize the patient is susceptible to:

Hepatitis A and B

Hepatitis B and C

Hepatitis B only

Hepatitis A only

21.  When evaluating illness symptoms in older patients, the disease will often present differently from younger adults due to:

The likelihood of polypharmacy.

Decreased compensatory mechanisms in the elderly.

An increased physiologic response to illness in the elderly.

Presence of comorbid conditions.

22. When prioritizing risk factors for bacterial endocarditis, the nurse practitioner knows who among the following patients has the highest risk.

A 55-year-old man with 3-vessel coronary artery bypass grafts with stents.

A 23-year-old woman with mitral valve prolapse without tissue redundancy.

A 65-year-old man with nonobstructive cardiomyopathy.

A 75-year-old woman with a nonorganic prosthetic aortic valve.

23. The legal authority for NPs to perform healthcare services as defined by state law is called:

Duty of care.

Non-malfeasance.

Autonomy.

Scope of practice.

24. When developing a management plan for patients with genitourinary infections, which of the following would you most likely recommend for follow-up imaging following resolution of their infection?

A 27-year-old nonpregnant woman with acute, uncomplicated urinary tract infection (UTI).

A 38-year-old nonpregnant woman with 2 acute, uncomplicated UTIs in the past 9 months.

A 57-year-old man with acute bacterial prostatitis.

A 43-year-old man with type 2 diabetes mellitus and recurrent pyelonephritis.

25. The NP is called to evaluate Jane, a 43-year- old woman, who presents with a diffuse maculopapular rash that began on the trunk but now covers the entire body, including the palms and soles. The rash is not itchy but wart-like sores are present in the mouth and genital area as well as skin folds. Initial evaluation reveals generalized lymphadenopathy and a low-grade fever, and she complains of lethargy and headache. The patient reports that she had a painless genital ulcer that healed on its own about 3 weeks earlier. Which of the following is the most likely diagnosis?

Primary syphilis.

Secondary syphilis.

Genital herpes.

Gonorrhea.

26. A 27-year-old man presents with a chief concern of an abnormal mass within his left scrotum. He describes it as feeling like a “bag of worms” and is present when he is standing but disappears when he lies down. His past medical history is unremarkable and his BMI is 29 kg/m 2 . He has been in a monogamous relationship for the past 4months. The most likely diagnosis is:

Testicular torsion.

Syphilis.

Varicocele.

Testicular cancer.

27. An 18-year-old man is being evaluated for a severe exacerbation of asthma. He is currently taking an inhaled corticosteroid, a long- acting beta-agonist, and a short-acting beta-agonist on an as needed basis. The most important component of the initial assessment includes a(n):

Continuous pulse oximetry reading

Peak expiratory flow reading

Chest X-ray

Arterial Blood Gas

28. A 67-year-old man is being evaluated for shortness of breath. His medical history reveals that he experienced a myocardial infarction about 2 years ago and a history of hypertension, which is well controlled by diet.. Otherwise, his medical history is unremarkable. Which of the following would you expect to find on electrocardiogram (ECG)?

T wave inversion.

Pathologic Q wave.

ST segment elevation.

Tall R wave.

29. A 74-year-old male with asymptomatic atrial fibrillation underwent electrical cardioversion that successfully restored the heart’s rhythm. Which of the following medications can be considered for the purpose of maintaining the heart’s rhythm?

Sotalol (Betapace ® )

Digoxin (Lanoxin ® )

Dabigatran (Pradaxa ® )

Enalapri

30. A 14-year-old male is brought in for evaluation after he reportedly collapsed during a tennis match, though he quickly regained consciousness. His medical history is otherwise unremarkable. You suspect hypertrophic cardiomyopathy. Which of the following heart murmur characteristics would support the diagnosis?

Occurs late in systole.

Widely split S?.

Becomes louder when going from a supine to standing position.

Murmur follows mid-systolic click.

31. You see a 64-year-old man with an area of erythema concentrated on the left side of his neck with clusters of vesicles forming a line. He reported pain in the area a couple of days before the eruption of the lesions. He states that he recently initiated biologic therapy for rheumatoid arthritis. Which of the following is the most likely diagnosis?

Impetigo.

Herpes zoster.

Drug-related adverse reaction.

Viral exanthem.

32. An NP’s duty of care can be established:

Only in the setting of a healthcare institution (e.g., hospital, clinic, etc.).

When the NP gives professional advice or treatment in any setting.

Only when a fee is charged, either to the patient or third-party payer, for services.

Only when both the NP and patient acknowledge a patient-provider relationship.

33. In managing a 58-year- old woman who is admitted for deep vein thrombosis, caution should be used with which of the following medications due to a risk of drug-induced thrombocytopenia?

Warfarin (Coumadin®)

Clopidogrel (Plavix®)

Dabigatran (Pradaxa®)

Unfractionated heparin

34. An 84-year-old female patient is admitted from a local long-term care facility (illnes). The patient is normally awake, alert, and oriented. She resides in the LTCF because she has not fully recovered from a broken hip resulting from a fall 4 months ago; otherwise she is in relatively good health. She can walk short distances with a walker, though she primarily stays in a wheelchair. Today, however, the nursing staff found her to be acutely confused and unable to ambulate without falling. She was transferred to the emergency department for evaluation. Initial laboratory testing must include:

2 sets of blood cultures.

Serum thyroid stimulating hormone (TSH) level.

Urinalysis.

Lumbar puncture.

35. A 23-year-old college student presents with a 2-day history of severe sore throat and difficulty eating or drinking due to trouble swallowing. A physical examination reveals exudative pharyngitis and minimally tender anterior and posterior cervical lymphadenopathy. The NP suspects infectious mononucleosis and would expect which of the following laboratory findings?

Neutrophilia with reactive forms.

Thrombocytosis.

Lymphocytosis with atypical lymphocytes.

Diminished ALT/AST levels.

36. “Incident-to” services are defined as those which are “an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness”. As long as certain criteria are met, “incident to” billing is an option in all of the following settings except:

Office visits.

Hospital.

Nursing home.

Home visits.

37. A 78-year- old male is being treated for a hypoglycemic episode. He has a long history of type 2 diabetes mellitus as well as congestive heart failure and COPD. He is currently taking basal insulin with a sulfonylurea. What is the acceptable A1C goal for this patient?

≤ 6.5%

≤ 7.0%

≤ 8.0%

≤ 9.0%

38. You see a 74- year-old male who is accompanied by his granddaughter who lives with him. He has hypertension, a prior myocardial infarction, long-standing type 2 diabetes, and recently underwent a lower limb amputation secondary to diabetes. He is currently taking an ACE inhibitor, statin, low-dose aspirin, biguanide, and insulin. The granddaughter reports that since the amputation, her grandfather sometimes becomes withdrawn, irritable and moody for no apparent reason, does not want to participate in the typical activities he enjoys, and often does not appear to eat much during the day. She also states that he often complains of being tired but normally wakes up in the early morning hours. The most appropriate action is to evaluate the patient for:

Dementia.

Depression.

Delirium.

Drug interaction.

39. You see a 58-year-old man who complains of a persistent dry, hacking cough. He reports that he recently started taking a medication to treat high blood pressure. He is most likely taking a(n):

Angiotensin-converting enzyme (ACE) inhibitor

Alpha-adrenergic antagonist

Angiotensin receptor blocker

Beta-adrenergic antagonist

40. A 77-year-old woman is accompanied by her husband for evaluation. She is currently being treated with metoprolol (Lopressor ® ) for hypertension and digoxin (Lanoxin ® ) for atrial fibrillation. He reports that his wife is becoming increasingly forgetful over the past year, failing to note important family events such as birthdays, and sometimes becomes confused with driving directions to familiar locations. She has no previous psychiatric history. The most likely diagnosis is:

Parkinson’s disease.

Delirium.

Dementia.

Early stage of congestive heart failure.

41. Mrs. Conner is a 76- year-old woman living in a long-term care facility and has been bedridden with a respiratory infection for the past 4 days. She is brought in for evaluation and you note signs of dehydration as well as a section of epidermal skin loss about 3 cm in diameter on her right hip. The dermal layer appears intact. This would be considered a pressure ulcer of Stage:

1

2

3

4

42. Which of the following represents the highest level of scientific evidence when evaluating clinical research?

A randomized controlled trial.

Systematic review/ Meta-analysis of randomized controlled troals.

Observational study.

Cohort study.

43. A 64-year- old woman with chronic kidney disease presents with a chief complaint of lethargy. His hemogram is as follows:

-Hemoglobin (Hg)=9.9 g/dL (12–14 g/dL

-Hematocrit (Hct)=30% (36%–42%)

-Mean cell volume (MCV)=81 fL (80–96 fL

-Reticulocytes=0.7% (1%–2%)

These findings are most consistent with:

Iron deficiency anemia.

Anemia of chronic disease.

Folate deficiency anemia.

Thalassemia trait.

44. You see a 68-year-old woman who is being treated for moderate depression. She complains that her medication is causing symptoms of dry mouth and constipation. She is most likely taking which of the following medications?

Venlafaxine (Effexor ® )

Citalopram (Celexa ® )

Fluoxetine (Prozac ® )

Nortriptyline (Pamelor ® )

45. All of the following persons are eligible for Medicare services except:

A 74-year-old ex-smoker with COPD and high income from assets.

A 69-year-old undocumented resident in the US with atrial fibrillation.

A 62-year-old with a permanent physical disability due to a motor vehicle accident.

A 72-year-old permanent legal resident (non-US citizen) with type 1 diabetes mellitus.

46. When initiating therapy with spironolactone for a patient who is also on an ACE inhibitor, you advise the patient to return in 5 days to check which of the following laboratory parameters?

Sodium

Calcium

Potassium

Chloride

47. When considering an end-of-life decision for a terminally ill person with Alzheimer-type dementia who can no longer communicate, all of the following can be used as an advanced directive except:

Testimony from a family member or close friend

A living will.

A “do not resuscitate” order.

A durable power of attorney for healthcare.

48. Which of the following types of clinical studies represents the lowest level of evidence used to guide medical decisions?

Clinical experience of renowned expert in field.

Non-randomized controlled study.

Observational study.

Case-control study.

49. Which of the following electrocardiogram (ECG) changes do you expect to find in a person with myocardial ischemia?calcium

Pathologic Q wave

Tall R wave

T wave inversion

ST segment elevation

50. Which of the following statements is false regarding end-of-life decision-making for a patient that is hopelessly and terminally ill?

A durable power of attorney for healthcare can be used to authorize another person to make healthcare decisions.

A videotaped or audiotaped discussion with the patient can include advanced directives.

Advanced directives are legally binding and recognized in all 50 states.

Living wills and do not resuscitate orders are examples of advanced directives.

51. The nurse practitioner is evaluating a 19-year- old male suffering from a severe headache. He has a history of headaches that tend to occur in clusters over a few days. He has unsuccessfully tried several therapeutic modalities. A positive response to which of the following interventions supports the diagnosis of cluster headache?

Oxygen therapy.

Beta-adrenergic blockade.

Tricyclic antidepressant.

Dietary reduction of amines.

52. All of the following are required Medicare terms and conditions for paying NP services except:

The services are within the NP’s scope of practice as defined by state law.

The services performed are those for which a physician would be able to bill Medicare. The services are performed in collaboration with a physician.

Separate charges are billed for NP services and facility charges.

53. A 28- year- old male with asthma presents with a chief complaint that he has to use his rescue inhaler multiple times each day. An evaluation reveals that he has moderate-to-severe asthma and requires Step 4 treatment. An appropriate regimen would include:

Low-dose inhaled corticosteroid (ICS)

Medium-dose ICS

Medium-dose ICS plus a long-acting beta?-agonist (LABA)

High-dose ICS plus LABA plus omalizumab (Xolair ® )

54. A 62-year-old woman presents in the emergency department complaining of severe toe pain that originated overnight. She has a history of renal disease and is currently taking a thiazide diuretic. Her BMI is 37 kg/m 2 . In considering a diagnosis of acute gouty arthritis, the nurse practitioner knows that the best diagnostic indicator is:

Serum uric acid.

Joint X-ray.

Erythrocyte sedimentation rate (ESR).

Analysis of joint aspirate for urate crystals.

55. Which of the following is the most appropriate antibiotic for a 57-year-old man with acute bacterial rhinosinusitis and who has type 2 diabetes mellitus, COPD and a beta-lactam allergy?

Cephalexin (Keflex ® ).

Amoxicillin-clavulanate (Augmentin ® ).

Trimethoprim with or without sulfamethoxazole (Primsol ® , Bactrim ® ).

Levofloxacin (Levaquin ® )

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prevention in health promotion.

(1)

There are three levels of prevention in health promotion. The levels are primary, secondary, and tertiary. Educating the patient is important in each level of prevention.

Primary prevention is for those who are in good health. Falkner (2018) states “Primary prevention occurs before the onset of illness or injury and may involve preventative treatments, such as vaccinations and wellness exams, to prevent the contraction of illness” (para. 23). It involves vaccinations, health promotion, and educating the patient on ways to prevent illness or disease. Primary prevention aims to arm individuals and communities with information to be able to make educated decisions.

Secondary prevention is for those who are at risk of developing a health problem. Falkner (2018) states “Secondary prevention focuses on the early detection and treatment of disease processes before they progress and cause irreparable damage” (para. 24). This level of prevention involves screenings, identifying and controlling risk factors, and taking the necessary actions as early as possible. For example, mammograms and colonoscopies are secondary prevention measures. By identifying risk factors and problems early on the patient can start treating the problem before it progresses further.

Tertiary prevention is for those who have already been diagnosed with a disease or illness that has caused permanent damage. Falkner (2018) states “The focus of this level of prevention is to help the patient achieve some semblance of normalcy and acclimate back into their lives and society” (para. 25). This type of prevention may involve rehabilitation, home health care, and educating the patient and family on ways to prevent further complications. For example, stroke rehab is considered to be tertiary prevention.

The level of prevention helps to determine the educational needs of the patient. The education provided is tailored to each individual patient. The nurse must provide health promotion strategies and measures that will benefit the patient at that given time.

 

Reference

Falkner, A. (2018). Grand Canyon University (Ed). Health promotion: Health & wellness across the continuum. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/2

(2)

In the past, the concept of health was described as the absence of the disease. The concept of health/ illness was influenced by religion and sometimes illnesses were associated with supernatural causes as punishments. Evil spirits were linked to someone’s environment (their background). Health has changed in current days, and it consists of complete physical, mental, social wellbeing; an individual’s self-realization and self-fulfillment. Wellness, illness, and overall well-being have evolved, in that the health industry now focuses on preventing diseases. We have and continue to achieve stages that include intellectual, social, emotional, physical, and spiritual health leading towards the optimum level of functioning.

As mentioned, health promotion was introducing as prevention rather than a disease being presented. Of course, diseases present themselves, but we strive for patients to take better care of themselves to avoid diseases. Health promotion then becomes part of public health science to create policies for better practice and stimulate through education to develop healthier habits and choices of lifestyle, reach optimal health goals. They include health screenings, pregnancy controls, vaccinations, and proper nutrition, etc. (Falkner, 2018).

Health promotion interventions are the actions, making real using expertise and studies creating the model called evidence-based practice. These practices help health care providers access what causes diseases as well as establish the best available care with the goal to improve the patient outcomes. The nurse’s role focuses on health promotion as being an advocate and to deliverer care/services, care manager, educator, and researcher. An example is; pregnancy control has been proved to have a better outcome with deliveries and healthier babies As a result, communities become more aware of health risks and acquire tools and knowledge to control diseases and more participative to prevent them (World Health Organization, 2018).

References

Falkner, A. (2018). Health Promotion: Health & Wellness Across the Continuum. Health Promotion in Nursing Care. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/2

World Health Organization (WHO). (2011). Policy and partnership for health promotion action addressing the determinants of health. Retrieved from https://www.who.int/bulletin/volumes/83/12/editorial31205html/en/

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: Legal and Ethical Considerations

Discussion: Legal and Ethical Considerations for Group and Family versus Individual Therapies

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Goals

Goals:

“Once almost an exclusive province of physicians’ and other health care providers, moral and ethical issues underlying provider/patient relationships and the difficult decisions resulting from the vast increase in treatment options are now in the domains of law, politics, journalism, health institution administrations, and the public” (Sultz & Young, 2006, p. 32). This discussion board assignment focuses on ethics and policy in health promotion.

1.  To apply the key theoretical and epidemiological concepts obtained.

2.  To understand the implications of health policy and ethics in health promotion.

Discussion Board Activities:

1. Research the terms morality, ethics, bioethics, and human rights. Identify the differences/similarities among these terms, so you can apply them to the following questions/discussions.

2. Apply these terms to a health promotion topic that affects your population focus.

3. Discuss how the current health care reform in the US and how it impacts our health care system.  How will it affect the population you will serve?  Make sure to apply morality, ethics, bioethics, economic solutions, and other key variables that you have learned for the semester (you will need to have a basic understanding of health care legislation). Who will provide the funding for it?

4. For this primary posting assignment you are allowed 400-500 words. Remember to cite references using APA format.

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Anxiolytic Therapy & PTSD Treatment

Week 5: Anxiolytic Therapy & PTSD Treatment

“I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help.”
—P.K. Philips, PTSD patient

For individuals suffering from posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge. Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments. As a psychiatric mental health nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.

This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of clients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies.

Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images

Assignment: Assessing and Treating Clients With Anxiety Disorders

Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.

Learning Objectives

Students will:
  • –Assess client factors and history to develop personalized plans of anxiolytic therapy for clients
  • –Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring anxiolytic therapy
  • –Evaluate efficacy of treatment plans
  • –Analyze ethical and legal implications related to prescribing anxiolytic therapy to clients across the lifespan.

sample that can be audit and submit with plagiarism less than 15%

 

Assessing and Treating Clients with Anxiety Disorder

Assessing and Treating Clients with Anxiety Disorders.

Anxiety disorders are the most prevalent category of mental illness and are characterized by chronic anxiety causing distress and interference in the individual’s life. According to DSM-5, excessive anxiety and worry must cause significant distress or impairment and occurs on more days than not for at least six months for diagnostic criteria (Stein et al., 2015) The disorder can be effectively treated with medication, psychotherapy, or a combination of the two modalities.

This paper addresses the pharmacology approach in treating a 46 year- old white male who is experiencing anxiety, and the impact pharmacokinetic and pharmadynamic processes will be explored to guide for the appropriate treatment.

Case Scenario

A 46-year-old white male who initially presented to ER with a complaint of chest pain and cardiac work- up was negative, and a PMHNP consult was sought for psychiatric evaluation. The client ‘s Hamilton Anxiety Rating Scale( HAM-A) was 26 indicating moderate to severe anxiety phase. The PMHNP decides to start the client on medications.

Options: Zoloft 50 mg Po Daily, imipramine 25 mg po BID, buspirone 10 mg BID. 

Decision: Zoloft 50 mg PO daily.

Rationale: Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs ) benzodiazepines, buspirone, and α2δ ligands such as pregabalin and gabapentin are recommended as first line treatments for anxiety disorders spectrum (Stahl, 2017) However,  SSRI and SNRIs are efficacious in the treatment of generalized anxiety disorder (GAD) and panic attack as in the case of our patient in the scenario. Additionally, in cases of co-occurring GAD and depression, a common comorbidity, SSRIs can provide effective treatment for both GAD and major depression ( Johnson & Coles, 2014) .

Selecting sertraline (Zoloft) was based on the fact it belongs to the family of SSRI, and well recognized in the treatment of GAD and panic attack. Secondly, possible side effects of Zoloft which include sexual dysfunction, gastrointestinal abnormalities (nausea and diarrhea), insomnia, weight gain, and agitation and/or hyperactivation (Kamo et al.,2016) were explored prior selecting Zoloft. The patient was overweight (15 lb), hence a healthy lifestyle will be important for education, and the rest of side effects can be monitored and managed early in treatment.

Sertraline affects the serotonin neurotransmitter in the synaptic cleft by blocking the serotonin transporter from returning the remaining serotonin to the presynaptic cell. Sertraline is well absorbed in gastrointestinal tract, highly protein bound, predominantly metabolized by CYP 450 system  with half-life of 24- 26 hrs and removed primarily  by kidneys ( Woo & Wayne, 2013).

Imipramine, a tricyclic antidepressant was not my first choice because its possible side effects: blurred vision, dry mouth, urinary retention, drowsiness, weight gain, hypotension, and seizures (Stahl,2017)

Buspirone (Buspar), a serotonin receptor partial agonist can be appropriate for augmentation but not as first line treatment of GAD. Additionally, Buspirone takes longer (2 – 4 weeks) to have a full effect, and due to its sedation side effect, it would not be appropriate in our patient who has history of increased alcohol intake.

The goals of treatment of anxiety disorders are resolution of symptoms and prevention of relapse.

The client returns in four weeks, responding well to medication, anxiety decreased HAM A 18 from 26.

Options : Increase dose to 75 mg daily, increase dose to 100 mg daily, no change in drug/ dosage

Decision # 2 Increase dose to 75 mg daily. 

Rationale: Sertraline dosing in panic, PTSD, and social anxiety begin with 25 mg/day; increase to 50 mg/day after 1 week thereafter, usually wait a few weeks to assess drug effects before increasing dose; maximum generally 200 mg/day; single dose (Stahl,2017).

Moreover, increasing dosage slowly will reduce the possibility of acquiring side effects from the medication (Stein et al., 2014)

The client returns in four weeks, reports further reduction in anxiety symptoms HAM- A 10 (mild anxiety)

Options: Maintain current dose, increase to 100 mg daily, add Buspirone. 

Decision: Maintain current dose

Rationale: Major errors in psychopharmacological treatment of anxiety disorders include not achieving full remission of symptoms but instead accepting partial response, and not providing an adequate trial of medications (8 to 12 weeks ) before switching, discontinuing, or augmenting ( Woo & Wayne, 2013) . The patient was responding pretty well to medication ( 50% reduction in symptoms) , and reported no side effects. Therefore, continuing the same dosage, providing regular follow up with the patient to ensure medication adherence would be appropriate to meet the goals of remission.

References

Johnson, E. M., & Coles, M. E. (2014). Failure and Delay in Treatment-Seeking Across Anxiety Disorders. Community Mental Health Journal49(6), 668-674. Retrieved from https://web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=29&sid=7eabbc3a-b3a4-4cbf-b934-aa75c2e5b6fd%40sessionmgr4007

Kamo, T., Maeda, M., Oe, M., Kato, H., Shigemura, J., Kuribayashi, K., & Hoshino, Y. (2016). Dosage, effectiveness, and safety of sertraline treatment for posttraumatic stress disorder in a Japanese clinical setting: a retrospective study. BMC Psychiatry16(1). Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=6&sid=2ee0b7c6-b1c7-44e7-9b93-42c3b9a745c3%40sessionmgr102

Stein, D. J., Craske, M. A., Friedman, M. J., & Phillips, K. A. (2014). Anxiety Disorders, Obsessive-Compulsive and Related Disorders, Trauma- and Stressor-Related Disorders, and Dissociative Disorders in DSM-5. American Journal of Psychiatry171(6), 611-613. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14010003

Woo, T. M., & Wynne, A. L. (2013). Pharmacotherapeutics for nurse practitioner prescribers(3rd ed.). Philadelphia, PA: F.A. Davis Co.

 

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

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