May 30, | nursing, med, NURS, Paper
Anita Douglas Community-Acquired Pneumonia shadow health transcript
Transcript
Started: Mar 25, 2020 | Total Time:59 min
Hi Dr. Douglas, My name is Danielle. I will be your provider today
Greet
03/25/20 12:48 AM CDT
Hello.
What is the reason for you visit today?
Question
03/25/20 12:48 AM CDT
I’m here because I’ve got an awful cough, a fever, and my chest feels like I’ve been kicked by a horse. I’m sure this is some kind of upper respiratory infection. I was hoping it would go away on its own, but it hasn’t, so my husband Jeffrey convinced me to come in. As amusing as it is for Jeffrey to serve me my meals, this has gone on long enough. I need to feel better.
I’m sorry to hear that you are so uncomfortable from your symptoms. Your frequent cough sounds like it’s aggravating your already uncomfortable chest pain. You have done a great job toughing it out so far, and we’ll find a treatment plan to help you feel better.
Empathize
03/25/20 12:52 AM CDT
Thank you.
When did your symptoms start?
Question
03/25/20 12:53 AM CDT
Most of my symptoms started three days ago. I developed this nasty cough, and my nose has been all stuffed up. That’s also when the chest pain started, and when I began to feel exhausted. The fever set in last night. That was the last straw, so Jeffrey brought me in.
How often do the symptoms occur?
Question
03/25/20 12:54 AM CDT
Most of my symptoms — the hacking cough, chest pain, fatigue, achiness, stuffy nose — started three days ago. The fever started yesterday. None of it has let up since.
Where is your pain?
Question
03/25/20 12:54 AM CDT
Most of the chest pain is located in the lower right part of my chest. Aside from that, I have some general aches and muscle soreness; this is mostly a deep, dull sort of ache, but it feels more severe when I cough.
I’m sorry to hear that you’re in constant pain, and that your cough makes your pain worse. I will work on finding a therapy that will give you some relief.
Empathize
03/25/20 12:56 AM CDT
I appreciate your saying that.
Are you coughing up any mucous?
Question
03/25/20 12:58 AM CDT
I’m coughing up rust-colored sputum.
Are there any factors that make your symptoms worse? (Clarified to Does anything make your symptoms worse?.)
Question
03/25/20 12:59 AM CDT
Coughing makes this chest pain much worse. Deep breathing also seems to aggravate it, or talking too much. I also can’t move around too much . . . I’ve been staying in bed because any kind of activity makes my pain worse and leaves me exhausted. (Clarified to if anything makes my symptoms worse.)
What helps relieve your symptoms
Question
03/25/20 1:00 AM CDT
Rest has helped me feel a little better. Exerting myself in any way just makes me feel worse. Jeffrey has also been bringing me hot tea and soup. We’ve also kept my humidifier going. Other than that, I tried taking aspirin to help with my fever and chest pain, but that didn’t give me much relief.
how bad is the pain?
Question
03/25/20 1:00 AM CDT
I think that this cough is pretty severe. It brings my chest pain up from a 2 out of 10 to a 5 out of 10.
sorry to hear that
Empathize
03/25/20 1:01 AM CDT
Well, that’s very nice.
Lets talk about your past medical history (Clarified to What is your past medical history?.)
Question
03/25/20 1:01 AM CDT
I have hypertension and chronic kidney disease. stage 2. (Clarified to what health problems I have had.)
how long have you had the conditions? (Clarified to How long have you had your preexisting health problems?.)
Question
03/25/20 1:02 AM CDT
I was diagnosed with stage 2 chronic kidney disease 9 years ago, when I had some blood work done for my hypertension. I don’t know how long I had it before that, but I was diagnosed with hypertension 14 years ago, so it could have been a long time. (Clarified to how long I have had my preexisting health problems.)
any recent hospitalizations?
Question
03/25/20 1:03 AM CDT
I have not been hospitalized recently.
do you have any allergies
Question
03/25/20 1:03 AM CDT
No, I don’t have allergies.
Are you up to date on vaccines?
Question
03/25/20 1:04 AM CDT
Let me think . . . I had a flu shot about three months ago. Other than that, it’s been quite a while since I’ve needed any vaccines. I had a pneumococcal vaccine 12 years ago.
You are due for a pneumococcal vaccine, which you should receive again in your adulthood five to ten years after your first shot. These vaccines protect against the bacteria that most commonly cause pneumonia.
Educate
03/25/20 1:07 AM CDT
Alright.
What medications do you take?
Question
03/25/20 1:09 AM CDT
I take two prescription medications; a trandolapril/verapamil combo and chlorothiazide. I also take two supplements, vitamin D and calcium. And for the last three days I’ve been taking aspirin.
tell me about the trandolapril/verapamil
Question
03/25/20 1:10 AM CDT
I take my trandolapril/verapamil once a day for my stage 2 chronic kidney disease and hypertension.
how long have you taken the chlorothiazide?
Question
03/25/20 1:11 AM CDT
I have taken chlorothiazide for 14 years.
whats is the dosage of your medications?
Question
03/25/20 1:11 AM CDT
The trandolapril/verapamil combination is 2 milligrams of trandolapril and 180 milligrams of verapamil. The chlorothiazide pill is 500 milligrams. The aspirin is 325 milligrams each pill. As for the supplements: the calcium is 1200 milligrams and the vitamin D is 15 micrograms.
are you compliant with all of your medications? (Clarified to Are you compliant with your medications?.)
Question
03/25/20 1:12 AM CDT
I never miss doses of my medication. Jeffrey and I are very diligent, and the pillbox keeps track for us. (Clarified to if I am compliant with medication.)
That is great
Empathize
03/25/20 1:13 AM CDT
Thank you. I appreciate that.
what you taken any antibiotics? (Clarified to Have you taken antibiotics recently?.)
Question
03/25/20 1:13 AM CDT
I haven’t taken any antibiotics in some time . . . I honestly can’t remember when that would’ve been. (Clarified to if I have taken antibiotics recently.)
Do you drink, smoke, or use illicit substances?
Question
03/25/20 1:14 AM CDT
I’ve never used any illicit drugs.
do you exercise?
Question
03/25/20 1:15 AM CDT
I try to stay active by taking a few short walks a week. Jeffrey and I will walk around our neighborhood for about ten minutes. We try to do this two or three times a week. Unfortunately, right now all I can do is rest.
any difficulties with activities of daily living? (Clarified to Do you have trouble performing daily activities?.)
Question
03/25/20 1:16 AM CDT
I’ve been struggling a little with everything of late, but I am quite capable in general, thank you. [AUDIO COMING SOON] (Clarified to if I have trouble performing daily activities.)
tell me about your diet?
Question
03/25/20 1:16 AM CDT
In the morning, Jeffrey and I will have a piece of toast with some eggs, or maybe a fresh croissant that he picks up from the bakery around the corner. We normally eat a very light lunch — a sandwich, or some homemade soup — and for dinner we like to go out to eat a few times a week. Normally we get pasta, or a salad.
For people with hypertension and with chronic kidney disease, some foods are healthier and safer than others. It’s important to consider how your health will be affected when making everyday meal choices.
Empathize
03/25/20 1:18 AM CDT
That’s kind of you to say.
whats your family medical history
Question
03/25/20 1:20 AM CDT
My parents have both passed away. My mother was fairly healthy, but my father had hypertension. [AUDIO COMING SOON]
just want to follow up on the aspirin (No matching questions found.)
Question
03/25/20 1:20 AM CDT
How often do you take the aspirin
Question
03/25/20 1:20 AM CDT
Not normally, but since I got sick three days ago, I have been taking two aspirins three times a day. That’s a 325 milligram pill.
does it help with pain?
Educate
03/25/20 1:21 AM CDT
I’ll keep that in mind.
does it help with pain (No matching questions found.)
Question
03/25/20 1:21 AM CDT
does the aspirin relieve your pain
Question
03/25/20 1:22 AM CDT
It has done a little good, I suppose, both for my chest pain and my fever . . . I suppose it’s hard to tell, though, because I’ve been taking it since my symptoms started, so I haven’t really felt how bad my symptoms are sans aspirin. [AUDIO COMING SOON]
While it’s great that the aspirin has relieved your symptoms, it is not approved for older adults nor for people taking some of your medications. Always ask a healthcare provider before starting a new medication.
Educate
03/25/20 1:24 AM CDT
I’ll remember that.
Hi, i will educate you on the new prescription
Question
03/25/20 1:38 AM CDT
I appreciate it.
Take the medication with a full glass of water
Question
03/25/20 1:38 AM CDT
Shouldn’t be a problem.
Take the full course of medications
Question
03/25/20 1:39 AM CDT
I’ll be sure to take the whole course.
Be sure to avoid the sun
Question
03/25/20 1:39 AM CDT
I won’t be leaving my bed much anyway.
Contact your doctor if you experience rapid weight gain
Question
03/25/20 1:40 AM CDT
Alright then.
call 911 if you show signs of a severe allergic reaction
Question
03/25/20 1:40 AM CDT
I’ll have Jeffrey call 911 if that happens.
take tylenol for pain and fever
Question
03/25/20 1:41 AM CDT
Thanks for that.
guaifenesin will help with your cough
Question
03/25/20 1:41 AM CDT
Good to know.
you should start feeling better in a few days
Question
03/25/20 1:42 AM CDT
Hmm. Okay.
drink plenty of fluids
Question
03/25/20 1:42 AM CDT
I can do that. Does tea work?
yes Mrs Douglas
Question
03/25/20 1:42 AM CDT
That works for me.
THank you
Question
03/25/20 1:42 AM CDT
Alright. Thank you for all of your help today.
May 30, | nursing, med, NURS, Paper
NURS 6512: Advanced Health Assessment and Diagnostic Reasoning Final Exam
NURS 6512: Advanced Health Assessment and Diagnostic Reasoning Final Exam
Question 1
Breath odors may clue the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify:
diabetic ketoacidosis.
hepatic dysfunction.
tuberculosis.
uremia.
D
Question 2
A parent is advised to restrict contact or collision sports participation for their child. An example of a sport in which this child could participate is: NURS 6512: Advanced Health Assessment and Diagnostic Reasoning Final Exam
hockey.
roller skating.
skateboarding.
riflery.
D
Question 3
To assess a cremasteric reflex, the examiner strokes the:
abdomen and observes whether the umbilicus moves away from the stimulus.
skin around the anus and observes for the anal wink.
inner thigh and observes whether the testicle and scrotum rise on the stroked side.
palm and observes whether the fingers attempt to grasp.
Question 4
Inspection of the scrotum should reveal:
two testes per sac.
smooth scrotal sacs.
left scrotal sac lower than the right.
lightly pigmented skin.
C
Question 5
One of the most important aspects to consider in the orthopedic screening examination is:
symmetry.
muscle contraction.
balance.
flexibility.
Question 6
Tarry black stool should make you suspect:
upper intestinal bleeding.
rectal fistula.
prostatic cancer.
internal hemorrhoids.
Question 7
Which one of the following is a proper technique for use of a speculum during a vaginal examination?
Insert one finger; insert opened speculum.
Press introitus downward; insert closed speculum obliquely.
Allow labia to spread; insert speculum slightly open.
Spread labia; insert closed speculum horizontally.
D
Question 8
The Mini-Mental State Examination should be administered for the patient who:
has repetitive ritualistic behaviors.
uses illegal hallucinogenic drugs.
sleeps an excessive amount of time.
gets lost in her neighborhood.
Question 9
If pitting edema is unilateral, you would suspect occlusion of a:
superficial artery.
major vein.
surface capillary.
lymphatic duct.
B
Question 10
You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and cannot be easily retracted. You should:
chart the finding as paraphimosis.
transilluminate the glans.
inquire about previous penile infections.
retract the foreskin firmly.
Question 11
Postural hypotension is defined as a _____ when the patient stands, compared with sitting or supine readings.
systolic pressure drop of more than 15 mm Hg with a pulse rate increase
pulse rate decrease with a systolic pressure increase of at least 15 mm Hg
pulse rate decrease and diastolic pressure decrease of more than 5 mm Hg
diastolic pressure increase of more than 5 mm Hg and no pulse rate changes
Question 12
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:
determining tactile fremitus.
percussing all lung fields.
estimating diaphragmatic excursion.
auscultating the lung bases.
Question 13
A red, hot swollen joint in a 40-year-old man should lead you to suspect:
cellulitis.
bursitis.
trauma.
gout.
D
Question 81
You are examining a patient in the emergency department who has recently sustained head trauma. In order to initially assess this patient’s neurologic status, you would:
test the six cardinal points of gaze.
observe for swallowing and test the gag reflex.
palpate the jaw muscles as the patient clenches teeth.
ask him to discriminate between the smell of orange and peppermint.
A
Question 14
While examining a 30-year-old woman, you note that one breast is slightly larger than the other. In response to this finding, you should:
tell the patient to get a mammary sonogram as soon as possible.
ask the patient if she has ever had breast cancer.
tell the patient to get a mammogram as soon as possible.
note the finding in the patient’s record.
Question 15
The Mini-Mental State Examination:
will determine the cause of memory loss.
scores do not vary with regard to age or education.
may be used to quantitatively estimate cognitive changes.
may be used to qualitatively estimate personality disorders.
C
Question 16
Breath sounds normally heard over the trachea are called:
bronchovesicular.
bronchial.
vesicular.
amphoric.
B
Question 17
Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the:
QRS complex.
ST segment.
P wave.
PR interval.
c
Question 18
The best way to ease the apprehension of a 3-year-old child before a physical examination is to:
hand the child a picture book.
explain that you will be gentle.
let the child hold the stethoscope while you listen.
tell the child he or she will get a lollipop for good behavior.
C
Question 19
A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarction. During the health history interview of his family history, he relates that his father had died of “heart trouble.” The most important follow-up question you should pose is which of the following?
“What age was your father at the time of his death?”
“Did your father’s father have heart trouble also?”
“Did your father have coronary bypass surgery?”
“What were your father’s usual dietary habits?”
A
Question 20
An examiner has rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection?
Trichomonas smear
Cytology smear
Haemophilus smear
Gonococcal culture
B
NURS 6512: Advanced Health Assessment and Diagnostic Reasoning Final Exam
Question 21
The goals of preparticipation sports evaluation include:
determining the best fit for positions in each sport.
identifying risk of injury or death during sports participation.
securing a legal contract before recommending limiting participation.
screening for steroid use or abuse.
B
Question 87
During a routine prenatal visit, Ms. T. was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T. that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings:
suggest that she is having twins.
indicate a need for hospitalization.
are usual conditions during pregnancy.
indicate the need for amniocentesis.
C
Question 88
The difference in blood pressure readings between the right and the left arms is considered normal up to _____ mm Hg.
20
25
5
10
Question 89
The presence of cervical motion tenderness may indicate:
vulvovaginitis.
pelvic inflammatory disease.
pregnancy.
nulliparity.
B
Question 90
When palpating breast tissue, the examiner should use the _____ at each site.
finger pads, gliding
fingertips, lifting
palms of the hands, gliding
ulnar surface of the hands, gliding
A
Question 91
Which portion of the physical examination is best done with the patient standing?
Neurologic
Musculoskeletal
Rectal
Spinal
D
Question 92
Adrian Thompson is a 19-year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her mother reports that Andrian, apart from occasional sinus infections, Andrian is not prone to respiratory problems. What potential risk factor is most important to assess with regards to Adrian’s current problem?
Anorexia symptoms
Cocaine use
Covid-19 contact
Last menses
Question 93
While collecting personal and social history data from a woman complaining of breast discomfort, you should question her regarding: NURS 6512: Advanced Health Assessment and Diagnostic Reasoning Final Exam
history of medication allergies.
alcohol, tobacco, and caffeine use.
level of personal education.
amount of personal income.
B
Question 94
A 25 yo AA female has come to the clinic because she has missed her menstrual period this month and 2 months before. She says her cycles are irregular and she wants to be on birth control to help regulate them. She states that her breasts have enlarged and that her nipples have turned a darker color. Your further response to this finding is to:
schedule an appointment with a surgeon.
suggest a pregnancy test
instruct her that this is a side effect of birth control injection therapy.
refer her to a gynecologist for pap smear
Question 95
Part of the screening orthopedic component of the examination includes evaluating the person while he or she is:
performing push-ups.
twisting at the waist.
crossing the arms over the chest.
duck walking.
Question 96
Functional assessment is most important during the examination of a(n):
infant.
young adult.
adolescent.
older adult.
D
Question 97
You are conducting a preparticipation physical examination for a 10-year-old girl with Down syndrome who will be playing basketball. She has slight torticollis and mild ankle clonus. What additional diagnostic testing would be required for her?NURS 6512: Advanced Health Assessment and Diagnostic Reasoning Final Exam
Mini-Mental State Examination
Visual acuity
Nerve conduction studies
Cervical spine radiograph
D
Question 98
Which one of the following techniques is used to detect a torn meniscus?
Drawer test
McMurray test
Thomas test
Trendelenburg test
Question 99
Assessing orientation to person, place, and time helps determine:
ability to understand analogies.
abstract reasoning.
state of consciousness.
attention span.
Question 100
When assessing a 17-year-old for nuchal rigidity, you gently raise his head off the examination table. He involuntarily flexes his hips and knees. To confirm your suspicions associated with this positive test, you would also perform a test for the _____ sign.
Babinski
obturator
Brudzinski
Kernig
D
NURS 6512: Advanced Health Assessment and Diagnostic Reasoning Final Exam
