You are the Director of Public Health for your state. Your state is comprised of mostly rural areas. These rural areas do not have access to many state resources, especially in terms of medical care. As director, it is your job to come up with a plan to improve access. How would you do this? Please explain your plan in detail. 1 page

FNU Physical Assessment in Health Care Quiz 5

Question

Question 1

Which nodes are also called Virchow nodes?

a. Internal mammary
b. Anterior axillary
c. Deep cervical
d. Supraclavicular
Question 2

To palpate the inguinal nodes, you should have the patient:

a. bend over a table and cough
b. lie supine, with the knees slightly flexed
c. lie supine, with the legs extended
d. stand with the back extended
Question 3

Which risk factor is least likely to result in someone contracting HIV infection?

a. Prostitution
b. Hemophilia
c. Intravenous drug use
d. Working with AIDS patients
Question 4

Which of the following organs does not have lymphatic vessels?

a. Brain
b. Kidneys
c. Liver
d. Lungs
Question 5

Which disorder is characterized by a single node that is chronically enlarged and nontender in a patient with no other symptoms?

a. Retropharyngeal abscess
b. Streptococcal pharyngitis
c. Mononucleosis
d. Toxoplasmosis
Question 6

Transillumination is performed during an examination of the lymphatic system to:

a. detect lymphatic pulsation
b. distinguish nodes from cysts
c. evaluate nodal contours
d. observe erythematous lesions
Question 7

Serum sickness is usually characterized first by the appearance of:

a. diffuse lymph node enlargement
b. joint pain
c. urticaria
d. fever
Question 8

The most important clue to the diagnosis of immunodeficiency disease in a child is:

a. family history
b. illness in siblings
c. previous hospitalizations
d. serious recurring infections
Question 9

Which of the following conditions will stimulate lymph node enlargement? (Select all that apply.)

a. Graves diseaseb

b. Lymphangiomac

c. Esophageal refluxd

d. Parotid swelling

Question 10

The nurse tells her patient with lymphadenopathy not to rub the swollen lymph node because this would result in:

a. spreading the infection
b. enlarging the node
c. slowing the lymphatic drainage
d. making the node more fibrotic

Question 11

The harder and more discrete a node, the more likely that there is a(n):

a. innocent cause
b. infection
c. malignancy
d. metabolic disease

Question 12

Tender nodes associated with cat scratch disease are usually found in which area?

a. Epitrochlear area
b. Popliteal area
c. Axilla
d. Inguinal area

Question 13

To find the infection site associated with acute lymphangitis, the examiner should look ________ to the inflammation.

a. proximal
b. distal
c. contralateral
d. anterior

Question 14

Which landmark is the dividing line between the anterior and posterior cervical triangles?

a. Clavicle
b. Cervical spine
c. Sternocleidomastoid
d. Sternum

Question 15

Which disorder is a dysfunction of cell-mediated immunity?

a. Acute idiopathic polyneuritis
b. Acquired immunodeficiency syndrome
c. Epstein-Barr virus (EBV) mononucleosis
d. Systemic lupus erythematosus (SLE)

Question 16

When examining lymph nodes near a joint in the arm or leg, which of the following maneuvers is likely to facilitate the examination?

a. Extension of the extremity
b. Circumduction of the extremity
c. Flexion of the extremity
d. Rotation of the extremity

Question 17

The most common causes of acute suppurative lymphadenitis are:

a. HIV and herpes zoster
b. Haemophilus influenzae and adenovirus
c. herpes simplex types 1 and 2
d. streptococcal and staphylococcal organisms

Question 18

What is the most frequent cause of edema of the lower extremities?

a. Deficiency of vitamins and minerals
b. Excessive walking or running
c. Prolonged sitting or standing
d. Use of table salt

Question 19

Which of the following findings indicates that the examiner is assessing a blood vessel rather than a lymph node?

a. A bruit
b. Inflammation
c. Tenderness
d. Redness

Question 20

Which nodes are most often associated with inflammation?

a. Shotty
b. Movable
c. Fixed
d. Tender

Question 21

Which bronchial structure(s) is(are) most susceptible to aspiration of foreign bodies?

a. Left mainstem bronchus
b. Terminal bronchioles
c. Right mainstem bronchus
d. Respiratory bronchioles

Question 22

While auscultating the lung fields, you note that the patient’s voice sound is intensified, the voice has a nasal quality, and e’s sound like a’s. This describes:

a. resonance
b. bronchophony
c. pectoriloquy
d. egophony

Question 23

You are documenting a rash between the eighth and ninth ribs on the lateral border.This intercostal space will be documented in terms of the:

a. rib immediately above it
b. rib immediately below it
c. number of centimeters it is positioned below the clavicle
d. number of inches it is positioned below the clavicle

Question 24

Which chest structure contains all the thoracic viscera except the lungs?

a. Manubrium
b. Mediastinum
c. Sternum
d. Xiphoid

Question 25

Your older clinic patient is being seen today as a follow-up for a 2-day history of pneumonia. The patient continues to have a productive cough, shortness of breath, and lethargy and has been spending most of the day lying in bed. You should begin the chest examination by:

a. percussing all lung fields
b. auscultating the lung bases
c. determining tactile fremitus
d.estimating diaphragmatic excursion

Question 26

When the umbilical cord is cut:

a. blood flows through the infants lungs more vigorously.
b. lungs fill with air
c. closure of the foramen ovale occurs
d. closure of the ductus arteriosus occurs

Question 27

Which of the following are signs and symptoms of atelectasis?

a. Diminished chest wall movement
b. Tachypnea
c. Bradypnea
d. Trachea deviated ipsilaterally
Question 28

Which type of apnea requires immediate action?

a. Primary apnea
b. Secondary apnea
c. Sleep apnea
d. Periodic apnea of the newborn

Question 29

To distinguish between a respiratory friction rub and cardiac friction rub, ask the patient to:

a. hold the breath
b. lean forward
c. say “99” while you palpate the anterior chest
d. identify the location of the pain

Question 30

When auscultating the apex of the lung, you should listen at a point:

a. even with the second rib
b. 4 cm above the first rib
c. higher on the right side
d. on the convex diaphragm surface

Question 31

Your trauma patient has no auscultated breath sounds in the right lung field. You can hear adequate sounds on the left side. A likely cause of this abnormality could be that the patient:

a. has a closed head injury
b. has fluid in the pleural space
c. is moaning and in severe pain
d. is receiving high-flow oxygen

Question 32

Which condition requires immediate emergency intervention?

a. Patient with pleuritic pain without dyspnea
b. Patient with fever and a productive cough
c. Patient with tachypnea but no chest retractions
d. Patient with absent breath sounds and dull percussion tones

Question 33

Which site of chest wall retractions indicates a more severe obstruction in the asthmatic patient?

a. Lower chest
b. Along the anterior axillary line
c. Above the clavicles
d. At the nipple line

Question 34

With consolidation in the lung tissue, the breath sounds are louder and easier to hear, whereas healthy lung tissue produces softer sounds. This is because:

a. consolidation echoes in the chest
b. consolidation is a poor conductor of sound
c. air-filled lung sounds are from smaller spaces
d. air-filled lung tissue is an insulator of sound

Question 35

Which term would you use to document a respiratory rate more than 20 breaths/min in an adult?

a. Dyspnea
b. Orthopnea
c. Platypnea
d. Tachypnea

Question 36

Which finding suggests a minor structural variation?

a. Barrel chest
b. Clubbed fingers
c. Pectus carinatum
d. Chest wall retractions

Question 37

Which symptom is the most significant indicator of asthma and should be identified in the health history?

a. Wheezing
b. Paroxysmal dyspnea
c. Coexistent skin conditions
d. Chest pain

Question 38

To distinguish crackles from rhonchi, you should auscultate the lungs:

a. before and after the patient coughs
b. first at the lung base and then at the apex
c. with the patient inhaling and then exhaling
d. with the patient recumbent and then sitting

Question 39

Which of the following is an expected finding in newborns?

a. Mottling of the thorax
b. Sternal retractions
c. Cough
d. Sneezing

Question 40

You would expect to document the presence of a pleural friction rub for a patient being treated for:

a. pneumonia
b. atelectasis
c. pleurisy
d. emphysema

For the following Case Study, as follow is Discussion Question: As an NP student, needs to determine the medications for constipation.

According to the ACC/AHA Guidelines, what medication should this patient be prescribed for constipation? Write her complete prescriptions using the prescription writing format.

Support with 1 journal no older than 5 years.

Week 7: DISCUSSION QUESTION IN DISCUSSION BOARD

Gastroenterology-Motility Case Study

ACC/AHA Guidelines

Chief complaint: “ I have chronic constipation, incomplete defecation and abdominal bloating” for past 2 years.

HPI: M.C. a 46-year-old hispanic female presents to the GI-Motility clinic for complaint of chronic constipation, incomplete defecation and abdominal bloating. She has pmhx of DM-type 2, IBS-Constipation, Tubular Adenoma.

She also indicates that she has noticed that her symptoms are worsening for past 3 months. She has associated her symptoms with abdominal bloating, straining and incomplete defecation.

She has tried Miralax one packet po daily for at least 8 weeks and it has not relieved her symptoms.

Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.

PMH:

Diabetes Mellitus, type 2

Constipation, chronic-IBS

Surgeries: None

Allergies: Penicillin

Vaccination History:

She receives an annual flu shot. Last flu shot was this year

Social history:

High school graduate, married and no children. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis.

mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: + 1 pitting leg edema. + Varicose veins.

Skin: + rash crusted white in feet and inter-digit in feet.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored

HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: +Dryness, No open lesions. +Dry crusts in sole of feet. + moist crust in between toes.

PSYCH: Normal affect. Cooperative.

Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal

A:

Primary Diagnosis: Chronic Constipation, ideopathic

Secondary Diagnoses:

Incomplete Defecation

IBS-Constipation

Differential Diagnosis:

Small intestine bacterial overgrowth (SIBO)

Plan: Medications:

Miralax one packet po daily for at least 8 weeks.

Plan: Tests

Anorectal Manometry with rectal sensation/tone compliance test to evaluate if patient has dyssynergic defecation. If test positive then will consider ordering sessions of Biofeedback bowel retraining program to correct cause of incomplete defecation.

Labs: No new labs are needed.

Referrals: may refer based on effect of medication therapy given for 2 weeks.

Follow up: return to office in 8 weeks to reevaluate her symptoms.

Questions: As an NP student, needs to determine the medications for constipation.

According to the ACC/AHA Guidelines, what medication should this patient be prescribed for constipation? Write her complete prescriptions using the prescription writing format.

Imagine that you are a sophomore at Premier College. Over the past few months, you have not been well due to increased amounts of academic pressure and found yourself unable to concentrate in class or sleep well at night. You went to the student medical center for evaluation and, after consulting with the staff doctor, you were issued a prescription for the treatment of depression.

A few days later, one of your professors tells you that he too has had to take medicine for depression in the past. You ask him how he knew about your situation, and he replied that all student medical records are available to every instructor and staff member at Premier College. Hearing this, you feel that your privacy rights have been violated.

That afternoon you research privacy rights on the Internet and learn that filing a HIPAA privacy complaint to the OCR had been a tedious process before July 2009. On July 27, 2009, the Secretary of Health and Human Services (HHS) delegated to the Director of OCR the authority to administer and enforce the HIPAA Security Rule. This action improved HHS’ ability to protect individuals’ health information by combining the authority for administration and enforcement of federal standards for health information privacy and security. Those standards are outlined in the HIPAA legislation. With the new regulation, the process of filing a privacy complaint has become simpler and more effective.

Then you research the steps involved with filing a privacy complaint with the OCR (http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html), download the Health Information Privacy Complaint form at (http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/complaints/hipcomplaintform.pdf), and complete the form. While working on the form, you realize some sections are critical to your case and must be addressed carefully.

You decide to write about your experience in a paper for your Legal Issues in Information Security class. For this assignment:

1. Identify the early iterations of the HIPAA act and how the law has been modified to facilitate easier access to consumer complaints and enforcement.

2. Describe the overall process of submitting a health information privacy complaint to the OCR.

3. Identify specific sections of the complaint form that need critical attention while completing the form.

4. Analyze a few situations that can occur if the critical sections are not well identified.

5. Draft a brief summary, collating all your findings.

Required Resources

Access to the Internet
http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html
http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/complaints/hipcomplaintform.pdf

Submission Requirements

§ Format: Microsoft Word

§ Font: Arial 12-point size, Double-space

§ Citation Style: Follow your school’s preferred style guide

§ Length: No more than 500 words