1. CC: “I have been having terrible chest and arm pain for the      past 2 hours and I think I am having a heart attack.”

HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.

Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

1 of 2 Questions:

Why is HDL considered the “good” cholesterol?

2 points   

QUESTION 2

1. CC: “I have been having terrible chest and arm pain for the      past 2 hours and I think I am having a heart attack.”

HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.

Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

2 of 2 Questions:

Explain the role inflammation has in the development of atherosclerosis.

3 points   

QUESTION 3

1. A 45-year-old woman with a history of systemic lupus      erythematosus (SLE) presents to the Emergency Room (ER) with complaints of      sharp retrosternal chest pain that worsens with deep breathing or lying      down. She reports a 3-day history of low-grade fever, listlessness and      says she feels like she had the flu. Physical exam reveals tachycardia and      a pleural friction rub. She was diagnosed with acute pericarditis.

Question:

What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?

1 points   

QUESTION 4

1. A 15-year-old adolescent male comes to the clinic with his      parents with a chief complaint of fever, nausea, vomiting, poorly      localized abdominal pain, arthralgias, and “swollen lymph nodes”. States      he has felt “lousy” for a couple weeks. The fevers have been as high as      102 F. His parents thought he had the flu and took him to an Urgent Care      Center. He was given Tamiflu® and sent home. He says the Tamiflu didn’t      seem to work. States had a slight sore throat a couple weeks ago and      attributed it to the flu. Physical exam revealed thin young man who      appears to be uncomfortable but not acutely ill. Posterior pharynx      reddened and tonsils 3+ without exudate. + anterior and posterior cervical      lymphadenopathy. Tachycardic and a new onset 2/6 high-pitched,      crescendo-decrescendo systolic ejection murmur auscultated at the left      sternal border. Rapid strep +. The patient was diagnosed with acute      rheumatic heart disease (RHD).

Question:

Explain how a positive strep test has caused the patient’s symptoms.

1 points   

QUESTION 5

1. The APRN sees a 74-year-old obese female patient who is 2 days      post-op after undergoing left total hip replacement. The patient has had      severe post op nausea and vomiting and has been unable to go to physical      therapy. Her mucus membranes are dry. The patient says she feels like the      skin on her left leg is too tight. Exam reveals a swollen, tense, and red      colored calf. The patient has a duplex ultrasound which reveals the      presence of a deep venous thrombosis (DVT).

Question:

Describe the factors that could have contributed to the development of a DVT in this patient explain how each of the factors could cause DVT.

1 points   

QUESTION 6

1. A 45-year-old woman is 10 days status post partial small bowel      resection for Crohn Disease and has been recuperating at home. She      suddenly develops severe shortness of breath, becomes weak, and her blood      pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse      oximetry is 89% on room air. The APRN suspects the patient experienced a      massive pulmonary embolus.

Question:

Explain why a large pulmonary embolus interferes with oxygenation.

1 points   

QUESTION 7

1. A 45-year-old woman is 10 days status post partial small bowel      resection for Crohn Disease and has been recuperating at home. She      suddenly develops severe shortness of breath, becomes weak, and her blood      pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse      oximetry is 89% on room air. While waiting for the Emergency Medical      Service (EMS) to arrive, the APRN places EKG leads and the EKG      demonstrates right ventricular strain.

Question:

Explain why a large pulmonary embolism causes right ventricular strain.

1 points   

QUESTION 8

1. A 12-year-old girl is brought to the Emergency Room (ER) by      her mother with complaints of shortness of breath, wheezing, tachypnea,      tachycardia, and a non-productive cough. The mother states they had just      come from a fall festival where the entire family enjoyed a hayride. The      symptoms began shortly after they left the festival but got better a      couple hours after they returned home. The symptoms began again about 6      hours later and seem to be worse. The mother states there is no history of      allergies or frequent respiratory infections. The child is up to date on      all vaccinations. The child was diagnosed with asthma. The nurse      practitioner explained to the mother that her child was exhibiting      symptoms of asthma, and probably had an early asthmatic response and a      late asthmatic response.

Question 1 of 2:

Explain early asthmatic responses and the cells responsible for the responses.

2 points   

QUESTION 9

1. A 12-year-old girl is brought to the Emergency Room (ER) by      her mother with complaints of shortness of breath, wheezing, tachypnea,      tachycardia, and a non-productive cough. The mother states they had just      come from a fall festival where the entire family enjoyed a hayride. The      symptoms began shortly after they left the festival but got better a      couple hours after they returned home. The symptoms began again about 6      hours later and seem to be worse. The mother states there is no history of      allergies or frequent respiratory infections. The child is up to date on      all vaccinations. The child was diagnosed with asthma. The nurse      practitioner explained to the mother that her child was exhibiting      symptoms of asthma, and probably had an early asthmatic response and a      late asthmatic response.

Question 2 of 2:

Explain late asthmatic responses and the cells responsible for the responses.

2 points   

QUESTION 10

1. A 64-year-old man with a 40 pack/year history of cigarette      smoking has been diagnosed with emphysema.  He asks the APRN if this      means he has COPD.

Question 1 of 2:

Explain the pathophysiology of emphysema and how it relates to COPD.

2 points   

QUESTION 11

1. A 64-year-old man with a 40 pack/year history of cigarette      smoking has been diagnosed with emphysema.  He asks the APRN if this      means he has COPD.

Question 2 of 2:

Explain the pathophysiology of chronic bronchitis and how it relates to COPD.

2 points   

QUESTION 12

1. Mr. Jones is a 78-year-old gentleman who presents to the      clinic with a chief complaint of fever, chills and cough. He also reports      some dyspnea. He has a history of right sided CVA, COPD, dyslipidemia, and      HTN. Current medications include atorvastatin 40 mg po qhs, lisinopril,      and fluticasone/salmeterol. He reports more use of his albuterol rescue      inhaler.

Vital signs Temp 101.8 F, pulse 108, respirations 21. PaO2 on room air 86% and on O2 4 L nasal canula 94%. CMP WNL, WBC 18.4. Physical exam reveals thin, anxious gentleman with mild hemiparesis on left side due to CVA. HEENT WNL except for diminished gag reflex and uneven elevation of the uvula, CV-HR 108 RRR without murmurs, rubs, or click, no bruits. Resp-coarse rhonchi throughout lung fields. CXR reveals consolidation in right lower lobe. He was diagnosed with community acquired pneumonia (CAP).

Question:

Patient was hypoxic as evidenced by the low PaO2. Explain the pathologic processes that caused this patient’s hypoxemia.

1 points   

QUESTION 13

1. A 64-year-old woman with moderately severe COPD comes to the      pulmonary clinic for her quarterly checkup. The APRN reviewing the chart      notes that the patient has lost 5% of her body weight since her last      visit. The APRN questions the patient and patient admits to not having      much of an appetite and she also admits to missing some meals because it      “takes too much work” to cook and consume dinner.

Question:

The APRN recognizes that COPD has a deleterious effect on patients. Explain why patients with COPD are at risk for malnutrition.

1 points   

 

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