NURS 6501 Knowledge Check Module 5
NURS
6501
Knowledge
Check:
Module 5
Student
Response
This
Knowledge Check reviews the topics in Module 5 and is formative in
nature. It is worth 20 points where each question is worth 1 point.
You are required to submit a sufficient response of at least 2-4
sentences in length for each question.
Scenario
1: Gout
A 52-year-old obese
Caucasian male presents to the clinic with a 2-day history
of fever, chills, and right great toe pain that has gotten
worse. Patient states this is the first time that this
has happened, and nothing has made it better and walking
on his right foot makes it worse. He has
tried acetaminophen, but it did not help. He took
several ibuprofen tablets last night which did give him a
bit of relief. Past medical history positive or hypertension
treated with hydrochlorothiazide and kidney stones. Social
history negative for tobacco use but admits to drinking “a fair
amount of red wine” every week. General appearance: Ill
appearing male who sits with his right foot
elevated. Physical exam remarkable for a temp of 101.2, pulse
108, respirations 18 and BP 160/88. Right great toe
(first metatarsal phalangeal [MTP]) noticeably swollen
and red. Unable to palpate to assess range of motion due to extreme
pain. CBC and Complete metabolic profile revealed WBC
14,000 mm3 and uric
acid 8.9 mg/dl. The APRN diagnoses the patient with acute gout.
1
of 2 Questions:
Describe
the pathophysiology of gout.
<Type
your response here>
2
of 2 Questions:
Explain
why a patient with gout is more likely to develop renal calculi.
<Type
your response here>
Scenario
2: Lyme Disease
Stan
is a 45-year-old man who presents to the clinic complaining of
intermittent fevers, joint pain, myalgias, and generalized fatigue.
He noticed a rash several days ago that seemed to appear and
disappear on different parts of his abdomen. He noticed the lesion
below this morning and decided to come in for evaluation. He denies
recent international travel and the only difference in his usual
routine was clearing some underbrush from his back yard about a week
ago. Past medical history non-contributory with exception of
severe allergy to penicillin resulting in hives and difficulty
breathing. Physical exam: Temp 101.1 ˚F, BP 128/72, pulse 102 and
regular, respirations 18. Skin inspection
revealed a 4-inch diameter bull’s eye type red
rash over the left flank area. The APRN, based on history and
physical exam, diagnoses the patient with Lyme Disease. She ordered
appropriate labs to confirm diagnosis but felt it urgent to
begin antibiotic therapy to prevent secondary complications.
Question:
What
is Lyme disease and what patient factors may have increased his
risk developing Lyme disease?
<Type
your response here>
Scenario
3: Osteoporosis
A 72-year-old female
was walking her dog when the dog suddenly tried to chase a
squirrel and pulled the woman down. She tried to break her fall
by putting her hand out and she landed on her outstretched hand.
She immediately felt severe pain in her right wrist and
noticed her wrist looked deformed. Her neighbor saw the fall and
brought the woman to the local Urgent Care Center for evaluation.
Radiographs revealed a Colles’ fracture (distal radius with
dorsal displacement of fragments) as well as radiographic
evidence of osteoporosis. A closed reduction of the fracture
was successful, and she was placed in a posterior
splint with ace bandage wrap and instructed to see
an orthopedist for follow up.
Question:
What
is osteoporosis and how does it develop?
<Type
your response here>
Scenario
4: Rheumatoid Arthritis
A 42-year-old woman
presents to the clinic with a four-month history
of generalized joint pain, stiffness, and swelling,
especially in her hands. She states that these symptoms
have made it difficult to grasp objects and has
made caring for her 6 and 4-year-old children problematic. She admits
to increased fatigue, but she thought it was due to
her stressful job as well as being a single mother. No
significant past medical history but recalls that one of her
grandmothers had “crippling” arthritis. Physical exam
remarkable for bilateral ulnar deviation of her hands as
well as soft, boggy proximal interphalangeal joints. The
metatarsals of both of her feet also exhibited swelling and
warmth. The diagnosis for this patient is rheumatoid arthritis.
Question:
Explain
why patients with rheumatoid arthritis exhibit these
symptoms and how does it differ from osteoarthritis?
<Type
your response here>
Scenario
5: Ankylosing Spondylitis (AS)
A 32-year-old Caucasian
male presents to the office with complaints of back pain, stiffness,
especially in the morning, interrupted sleep due to pain, and
difficulty in leaning over to tie his shoes. The patient first
noticed these symptoms about 6 months ago but attributed
them to his weekend basketball team’s games. He said
he is exhausted due to sleep interruption. He has taken
acetaminophen with some relief but says the naproxen seems to be
working better. Married with 2 small children and works as a
bank manager. Physical exam: Lungs clear but decreased chest
excursion noted as well as decreased range of motion of hips
and forward flexion, rotation, and lateral flexion
restricted. Spine radiographs in the office revealed a
slight kyphosis along with ankylosis at L5-S1. The
APRN suspects the patient may have ankylosing spondylitis (AS). The
APRN orders laboratory tests including an HLA-B27.
Question:
Why
did the APRN order an HLA-B27 lab? How would
that lab result assist in understanding what
ankylosing spondylitis?
<Type
your response here>
Scenario
6: Lateral Epicondylitis
A 17-year-old male
presents to the clinic with a chief complaint of pain in his
right elbow. He says the pain is sharp, especially
with pronation and supination. He noticed the pain several
weeks ago after his tennis team went to a regional
competition. When he rests, the pain seems to go away. The pain
is alleviated when he takes Naprosyn. No history of trauma
or infection in the elbow. Past medical and social history non
contributary. He is a junior at the local high school and just
started taking tennis lessons 2 months ago and his coach is
working with him on his backhand serve. Focused physical
exam revealed point tenderness over the lateral
epicondyle which increases with pronation and supination. The
APRN diagnoses him with lateral epicondylitis and orders a wrist
splint to prevent wrist flexion.
Question:
Why
did the APRN feel a wrist splint would be helpful? What patient
characteristics lead to this diagnosis.
<Type
your response here>
Scenario
7: Status Epilepticus
A
24-year-old Caucasian male was brought to the Emergency Room (ER) by
Emergency Medical System (EMS) after suffering a “convulsion”
episode at work that didn’t stop. Upon arrival to the ER, the
patient was noted to be actively seizing with tonic-clonic movements.
The patient’s boss accompanied him to the ER and gave a statement
that the patient appeared in his usual good health earlier in the
morning when they started working at their jobs in an auto parts
store. The boss didn’t know of any past medical history. The boss
brought along the patients next of kin information, and the patients
mother told the ER that the patient has a prior history of seizures
but hadn’t had a seizure in several years. The family thought he
had “outgrown them.” Past medical history, other than previous
seizures, and social history non-contributory. No history of alcohol
or drug abuse and had no history of vaping. The ER APRN diagnoses the
patient with status epilepticus and along with the ER staff,
initiated appropriate treatment.
Question:
What
is a seizure and why is status epilepticus so dangerous for
patients?
<Type
your response here>
Scenario
8: Multiple Sclerosis (MS)
A 32-year-old
while female presents to the Urgent Care with complaints of blurry
vision and “fuzzy thinking” which has been present for the
last several weeks or so. She works as an executive
for an insurance company and put her symptoms down to the stress of
preparing the quarterly report. Today, she noticed that her symptoms
were worse and were accompanied by some fine tremors in her hands.
She has been having difficulty concentrating and has difficulty
voiding. She remembers her eyes were bothering her a few months ago
and she went to the optometrist who recommended reading glasses with
small prism to correct double vision. She admits to some
weakness as well. No other complaints of fevers, chills, upper
respiratory tract infections,
or urinary tract infections. Past medical and social
history noncontributory. Physical exam significant
for 4th cranial
nerve palsy. The fundoscopic exam reveals edema of right optic
nerve causing optic neuritis. Positive nystagmus on
positional maneuvers. There are left visual field
deficits. There was short term memory loss with listing of
familiar objects. The APRN tells the patient that she
will be referred to a neurologist due to the high index of
suspicion for multiple sclerosis (MS).
Question:
What
is multiple sclerosis and how did it cause the above
patient’s symptoms?
<Type
your response here>
Scenario
9: Myasthenia Gravis (MG)
61-year-old
male complains of intermittent weakness and muscle fatigue that
has progressively worsened over the past month. He was
an internationally known extreme mountain climber but now he
says he has difficulty in getting his morning paper. Initially
he thought his symptoms of profound leg weakness and fatigue were
due to his age and history of injuries from mountain
climbing. Over the past few months, he also reports having
noticed “blurriness” when working on his antique
train collection or reading for long periods of time. He
has developed intermittent double vision that seems to be worse when
reading at bedtime. He also reports an occasional “droopy”
eye lid. Past medical and social history
noncontributory. Physical exam reveals weakness of right extra
ocular muscle (EOM) with repetition. There is positive
nystagmus and symmetrical upper extremity weakness
with fasciculations. Lower extremities within normal limits
(WNL). The APRN suspects the patient has myasthenia
gravis (MG).
Question:
What
is the underlying pathophysiology of MG?
<Type
your response here>
Scenario
10: Alzheimer’s Disease (AD)
A 67-year-old male
presents to the clinic along with his family with a chief
complaint of having problems with his short-term memory. His
family had dismissed these problems and attributed them to
the aging process. Over time they have noticed changes in his
behavior, along with increased confusion and difficulty completing
basic tasks. He got lost driving home from the
bowling alley and had to be brought home by the police department. He
is worried that he may have Alzheimer’s Disease (AD). Past
medical and social history positive for a minor cerebral
vascular accident when he was 50 years old but without any residual
motor or sensory defects. No history of alcohol or tobacco use.
Current medication is clopidogrel 75 mg po qd. Neurological
testing confirms the diagnosis of AD.
Question:
What
is Alzheimer’s Disease and how does amyloid beta factor
into the development and progression of the disease?
<Type
your response here>
Scenario
11: Spinal Cord Injury (SCI)
A 22-year-old male was
an unrestrained front seat passenger of a car
traveling at 50 miles per hour. The driver swerved to avoid
hitting a deer that darted in front of the car and hit
a tree. The patient was ejected from the
vehicle. He was awake and alert at the scene when
the paramedics arrived, and his pupils were equal and reactive
to light. He was placed in a hard-cervical collar per
protocol and log rolled onto a long backboard. He was breathing
spontaneously at the scene, but pulse oximetry in the EMS unit
revealed a SaO2 of
88% on room air. He was placed on 100% oxygen via non-rebreather mask
and was taken to a Level I trauma center with the following vital
signs:
Vital
signs: BP 90/50, Pulse 48 and regular, Respirations 24 and shallow
with some use of accessory muscles, temp 95.2 F rectally. He was
awake and answering questions appropriately but says he
cannot feel his arms or legs. Glasgow Coma Scale 14. His
skin was warm and dry with minor abrasions noted on his
arms. According to family members, past medical history
noncontributory and social history reveals only occasional
alcohol use and no tobacco or vaping history. Full work up in
the ED revealed a fracture-dislocation of
C4 with assumed complete tetraplegia (formerly
called quadriplegia). No other injuries noted He was
given several liters of IV fluid, but his blood
pressure remained low.
Question
1 of 2:
Explain the
differences between primary and secondary spinal cord injury (SCI)?
<Type
your response here>
Question
2 of 2:
What
is spinal shock and how it is different from neurogenic shock?
<Type
your response here>
Scenario
12: Traumatic Brain Injuries (TBIs)
A
22-year-old male was an unrestrained front
seat passenger of a car traveling at 50 miles per
hour. The driver swerved to avoid hitting a deer that darted in
front of the car and hit a tree. EMS on the scene noted a
stellate fracture of the windshield on the passenger side. The
patient was non-responsive at the at the scene when
the paramedics arrived, and his pupils were unequal with the
left pupil larger and sluggish to react to light. He was placed
in a hard-cervical collar per protocol and log rolled onto a long
backboard. He was breathing spontaneously at the scene, but pulse
oximetry in the EMS unit revealed a SaO2 of 78%
on room air. He was intubated at the scene for airway protection
and transported to a Level 1 trauma center. Glasgow Coma
Scale=3
After
a full trauma work up, the patient was diagnosed with an
isolated traumatic brain injury with acute subdural
hematoma secondary to coup-contrecoup mechanism of
injury. He was emergently taken to the operating room for
craniotomy after which he was taken to the Intensive Care Unit
(ICU) for close monitoring. He had an intracranial bolt for
measurements of his intracranial pressure (ICP).
Question
1 of 2:
Explain
the differences between primary and secondary traumatic brain
injuries (TBIs)?
<Type
your response here>
Question
2 of 2:
The
APRN is called by the ICU staff because the patient’s ICP has risen
to 22 mmHg. The APRN recognizes the urgent need to lower the ICP. The
APRN institutes measures to decrease the ICP and increase the
cerebral perfusion pressure (CPP). What are the factors that
determine CPP?
<Type
your response here>
Scenario
13: Transient Ischemic Attack (TIA)
A
68-year-old man was brought to the emergency department by his
family. During his routine morning walk he noticed a sudden onset of
left facial numbness associated with a dull headache on the right
posterior aspect of his head. He was staggering to the right side and
feeling unsteady and nauseated, with no vomiting. He telephoned his
wife, who noticed his speech was slow and slurred, but there was no
word-finding difficulty. His family immediately took him to the
hospital. There was a history of hypertension, hypercholesterolemia,
ischemic heart disease (MI and PCI with bare metal stent in 2007) and
probable transient ischemic attack (TIA) at the time of cardiac
intervention. His medication included atenolol, ramipril,
simvastatin, aspirin and clopidogrel.
Within
one hour, the patient’s symptoms had totally resolved. The
diagnosis of transient ischemic attack was made, and the patient was
discharged to home with instructions to contact his healthcare
provider (HCP) for follow-up.
Question:
Why
did the patient’s symptoms totally resolve?
<Type
your response here>
Scenario
14: Cerebral Artery Vascular Accident (CVA)
An 83-year-old
man presents with a history of atrial fibrillation (AF),
hypertension, and diabetes. His daughter, who accompanied the
patient, states that yesterday the patient had a period when he could
not speak or understand words, and that approximately 4 weeks prior
he staggered against a wall and was unable to stand unaided because
of weakness in his legs. She states that both instances lasted
approximately a half-hour. She was unable to persuade her father to
go to the emergency room either time. Today he suffered another
episode of right sided weakness, dysarthria, and difficulty
with speech. Past medical history: Hypertension for 15 years,
well controlled; diabetes for the past 10 years, and
hyperlipidemia. Medications: Diltiazem CD 300 mg daily;
lisinopril 40 mg daily; metformin 500 mg twice daily; aspirin 81 mg
daily and atorvastatin 20 mg po qhs.
Social
history: reported former smoker with 40 pack year history. Alcohol
-drinks one beer a day. Denies any other substance abuse. Review
of systems: Denies dyspnea, dizziness, or syncope; complains
that he cannot move or feel his right arm or leg.
Difficulty with speech.
Physical
exam: Vitals: height = 70 inches; weight = 185 pounds; body mass
index = 26.5; BP = 134/82 mm Hg; heart rate = 88 bpm at rest,
irregularly irregular pattern.
HEENT
remarkable for expressive aphasia, eyes with contralateral
homonymous hemianopsia.
No
loss of sensation but unable to voluntarily move right arm or
leg.
The
patient was diagnosed with a right middle cerebral artery
vascular accident (CVA) secondary to atrial
fibrillation (AF)
Question:
How
does atrial fibrillation contribute to the development of a
CVA?
<Type
your response here>
Scenario
15: Osteoarthritis (OA)
A 57-year-old male
construction worker comes to the clinic with a chief complaint
of pain in his right hip. The pain has progressively gotten
worse over the last 2 months and he has been having trouble
sleeping. There is little pain in the morning, but he
is a bit stiff. The pain increases as the day wears on. has
taken acetaminophen without any relief but states that the
ibuprofen does work a little bit. He is anxious since the hip
pain has limited his ability to work and he is afraid that his
boss will fire him if he cannot perform his usual duties. There
is no history of past trauma or infection in the joint. Past
medical history noncontributory. Social history without
history of alcohol, tobacco, or illicit drug use. Physical exam
remarkable for decreased range of motion of the right hip. BMI
34 kg/m2. Radiographs
in the office demonstrated asymmetrical joint space
narrowing of the right hip with osteophyte formation. Several
areas of the hip showed bone-on-bone contact with loss of the
articular cartilage. The APRN tells the patient he has
osteoarthritis (OA) and refers the patient to
an orthopedist for evaluation of his need for a total
hip replacement.
Question:
Describe
how osteoarthritis develops and forms and
distinguish primary osteoarthritis from secondary arthritis.
<Type
your response here>
Scenario
16: Fibromyalgia (FM)
A 34-year-old Caucasian
female presents to the clinic with a chief complaint of widespread
pain in her joints and muscles. She states that her skin seems
sensitive and sometimes it hurts to be touched. She has
had extreme fatigue for the past 4 months. She admits
to being depressed and it unable to sleep well. She has had to
drop out of her gardening club due to pain. She says
that bright lights and loud noises really bother her. Past
medical history noncontributory. Social history is significant
for her divorce from her husband 14 months ago. She is
the mother of 2 small children and works as an
administrative assistant as the local insurance
company. Physical exam remarkable for tender points over
her posterior supraspinatus muscles, occiput, trapezius,
gluteal area, and sacroiliac joints bilaterally. The APRN
tells the patient that she most likely has fibromyalgia, based
on her physical exam.
Question
1 of 2:
What are the
underlying causes of fibromyalgia?
<Type
your response here>
Question
2 of 2:
The
APRN tells the patient that the tender points are no longer used to
diagnose FM. She suggests that the patient takes the Widespread Pain
Index (WPI) and the Symptom Severity Inventory (SSI). The patient
asks the APRN what these tests are for. What is the APRN’s best
answer?
<Type
your response here>
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