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NR 507 Final Exam (100% Correct)
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Exam
Question 1. What term is used to describe a hernial protrusion of a
saclike cyst that contains meninges, spinal fluid, and a portion of the
spinal cord through a defect in a posterior arch of a vertebra?
Question 2. What provides the best estimate of the
functioning of renal tissue?
Question 3. Where are Langerhans cells found?
Question 4. Where in the lung does gas exchange occur?
Question 5. The tonic neck reflex observed in a newborn
should no longer be obtainable by:
Question 6. When renin is released, it is capable of which
action?
Question 7. The portion of the antigen that is configured for
recognition and binding is referred to as what type of determinant?
Question 8. Which sexually transmitted infection frequently
coexists with gonorrhea?
Question 9. How is the effectiveness of vitamin B12 therapy
measured?
Question 10. Carcinoma refers to abnormal cell proliferation
originating from which tissue origin?

Question 11. Which type of microorganism reproduces on the
skin?
Question 12. An infant has a crescendo-decrescendo systolic
ejection murmur located between the second and third intercostal spaces
along the left sternal border. A wide fixed splitting of the second heart
sound is also found. These clinical findings are consistent with which
congenital heart defect?
Question 13. An infant diagnosed with a small patent ductus
arteriosus (PDA) would likely exhibit which symptom?
Question 14. What is the function of erythrocytes?
Question 15. Which terms represent the correct nomenclature
for benign and malignant tumors of adipose tissue, respectively?
Question 16. What is the chance with each pregnancy that a
child born to two parents with the sickle trait will have sickle cell
disease (SCD)?
Question 17. What pulmonary defense mechanism propels a
mucous blanket that entraps particles moving toward the oropharynx?
Question 18. The concentration of the final urine is determined
by antidiuretic hormone (ADH), which is secreted by which gland?
Question 19. Why is the herpes virus inaccessible to antibodies
after the initial infection?
Question 20. Which renal change is found in older adults?
Question 21. Which immunoglobulin is present in blood,
saliva, breast milk, and respiratory secretions?
Question 22. Which hormone prompts increased anxiety,
vigilance, and arousal during a stress response?
Question 23. Which statement is true regarding maternal
antibodies provided to the neonate?
Question 24. The function of the tumor cell marker is to:
Question 25. Which statement is true concerning a fungal
infection?
Question 26. Which change is a result of puberty and defends
the vagina from infection?
Question 27. The number of persons living with a specific
disease at a specific point in time is referred to by which term?

Question 28. Which risk factor for hypertension is influenced
by genetic factors and lifestyle?
Question 29. Having ejected a mature ovum, the ovarian
follicle develops into a(n):
Question 30. The failure of bones to ossify, resulting in soft
bones and skeletal deformity, characterizes which disorder?
Question 31. What is the term that denotes the duration of time
or the intensity of pain that a person will endure before outwardly
responding?
Question 32. Aldosterone directly increases the reabsorption
of:
Question 33. Atrial fibrillation, rheumatic heart disease, and
valvular prosthetics are risk factors for which type of stroke?
Question 34. Which clinical manifestations are associated with
fibromyalgia?
Question 35. Prolonged high environmental temperatures that
produce dehydration, decreased plasma volumes, hypotension, decreased
cardiac output, and tachycardia cause which disorder of temperature
regulation?
Question 36. What is the leading cause of infertility in women?
Question 37. Which substance is a water-soluble protein
hormone?
Question 38. What is the target tissue for prolactin-releasing
factor?
Question 39. What is the cause of familial
hypercholesterolemia (FH)?
Question 40. Regarding type 2 diabetes, obesity is considered
to be what type of risk?
Question 41. Which four-step process correctly describes
muscle contraction?
Question 42. Adoption studies have shown that the offspring of
an alcoholic parent when raised by nonalcoholic parents have what
amount of an increased risk of developing alcoholism?
Question 43. Which hormone stimulates gonads to produce
both male and female hormones?

Question 44. A person with 47, XXY karyotype has the genetic
disorder resulting in which syndrome?
Question 45. Which would be considered a positive symptom
of schizophrenia?
Question 46. What term describes the loss of the
comprehension or production of language?
Question 47. Consanguinity refers to the mating of persons:
Question 48. The major sleep center is located in which section
of the brain?
Question 49. Which type of ion directly controls the
contraction of muscles?
Question 50. Bacteria gain access to the female urinary tract by
which means?
Question 51. A criterion for a diagnosis of generalized anxiety
disorder (GAD) is a period of excessive worrying that lasts for at least
how many months?
Question 52. What is the first indication of nephrotic syndrome
in children?
Question 53. An amniocentesis indicates a neural tube defect
when an increase in which protein is evident?
Question 54. What is the risk for the recurrence of autosomal
dominant diseases?
Question 55. Which term is used to identify the temporary
displacement of two bones causing the bone surfaces to partially lose
contact?
Question 56. The tear in a ligament is referred to as a:
Question 57. Why is prolonged diarrhea more severe in
children than it is in adults?
Question 58. The BRCA1 and BRCA2 mutations increase the
risk of which cancer in women?
Question 59. Insulin transports which electrolyte in the cell?
Question 60. What term is used to identify an interlacing
bundle of dense, white fibrous tissue that is richly supplied with nerves,
blood vessels, and lymphatic vessels?

Question 61. Which of the following is a lipid-soluble
hormone?
Question 62. The mucosal secretions of the cervix secrete
which immunoglobulin?
Question 63. The sudden apparent arousal in which a child
expresses intense fear or another strong emotion while still in a sleep
state characterizes which sleep disorder?
Question 64. What is the basic structural unit in compact bone?
Question 65. Parkinson disease is a degenerative disorder of
the brain’s:
Question 66. Which pain theory proposes that a balance of
impulses conducted from the spinal cord to the higher centers in the
central nervous system (CNS) modulates the transmission of pain?
Question 67. Saliva contains which immunoglobulin (Ig)?
Question 68. What type of fracture occurs at a site of a
preexisting bone abnormality and is a result of a force that would not
normally cause a fracture?
Question 69. An infant suddenly develops abdominal pain,
becomes irritable (colicky), and draws up the knees. Vomiting occurs
soon afterward. The mother reports that the infant passed a normal stool,
followed by one that looked like currant jelly. Based on these data,
which disorder does the nurse suspect?
Question 70. In 95% of children of delayed puberty, the
problem is caused by:
Question 71. Which characteristic is true of type II (white fast-
motor) muscle fibers?
Question 72. Neurofibrillary tangles characterize which
neurologic disorder?
Question 73. Which hormone triggers uterine contractions?
Question 74. How does the release (increase) of epinephrine
raise body temperature?
Question 75. Which hormone is linked to an increase in
appetite during puberty?
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NR 507 Week 1 Discussions Altered Immune
System and Altered Inflammatory Response
Week 1: Altered Immune System and Altered Inflammatory Response
Part One
This week’s graded topics relate to the following Course Outcomes
(COs).
1 Analyze pathophysiologic mechanisms associated with selected
disease states. (PO 1)
2 Differentiate the epidemiology, etiology, developmental
considerations, pathogenesis, and clinical and laboratory manifestations
of specific disease processes. (PO 1)
3 Examine the way in which homeostatic, adaptive, and compensatory
physiological mechanisms can be supported and/or altered through
specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic
processes. (PO 1)

7 Explore age-specific and developmental alterations in physiologic and
disease states. (PO 1, 4)
Discussion Part One (graded)
John is a 19-year-old college football player who presents with sneezing,
itchy eyes, and nasal congestion that worsens at night. He states that he
has a history of asthma, eczema and allergies to pollen. There is also one
other person on the football team that has similar symptoms. His vitals
are BP 110/70, P 84, R 18, T 100 F. Write a differential of at least five
(5) possible items from the most likely to less likely. For each disease
include information about the epidemiology, pathophysiology and
briefly argue why this disease fits the presentation and why it might not
fit the presentation Week 1: Altered Immune System and Altered
Inflammatory Response
Discussion Part Two
A patient has been admitted into the emergency room that was in the
passenger side of a car that collided with another car head on. The
patient is pale, barely conscious and has a weak and thread pulse. An IV
is started. The vitals are BP 80/50, P 140, T 96.0 and R 26. As the team
fights to keep the patient alive they have to remove the spleen. Blood is
given but it has been mistyped. A transfusion reaction occurs. Describe
the type of hypersensitivity reaction that has occurred and discuss the
molecular pathophysiology of the specific type of hypersensitive
reaction you have chosen.
In the event that this patient survived the car accident and the transfusion
reaction which organs are most likely to be damaged and why?
Discussion Part Three

(COs).
specific therapeutic interventions. (PO 1,
4 Distinguish risk factors associated with selected disease states.(PO 1)
processes. (PO 1)
Discussion
A 44-year-old patient presents with lump in the chest of approximately 2
cm in diameter. There is a slight dimple over the location of the lump
and when the lump is manipulated it seems to be attached to the
surrounding tissue. A lumpectomy is performed and the mass is sent to
pathology. The pathology report comes back and the mass is confirmed
to be an estrogen receptor negative, a progesterone receptor negative and
a her2/neu receptor positive breast cancer.

What are some of the risk factors for breast cancer? What tumor
suppressor genes are associated with breast cancer?
What tumor oncogenes are associated with breast cancer?
Compare and contrast tumor suppressor genes from oncogenes?
**********************************
NR 507 Week 2 Discussions Respiratory
Disorders and Alterations in Acid/Base
Balance,Fluid and Electrolytes
Week 2: Respiratory Disorders and Alterations in Acid/Base Balance,
Fluid and Electrolytes – Discussion Part One
(COs).
Analyze pathophysiologic mechanisms associated with selected disease
states. (PO 1)

Differentiate the epidemiology, etiology, developmental considerations,
pathogenesis, and clinical and laboratory manifestations of specific
disease processes. (PO 1)
Examine the way in which homeostatic, adaptive, and compensatory
Distinguish risk factors associated with selected disease states. (PO1)
Describe outcomes of disruptive or alterations in specific physiologic
processes. (PO 1)
Distinguish risk factors associated with selected disease states. (PO1)
Explore age-specific and developmental alterations in physiologic and
Discussion Part One (graded)
A five-month-old Caucasian female is brought into the clinic as the
parent complain that she has been having ongoing foul-smelling , greasy
diarrhea. She seems to be small for her age and a bit sickly but, her
parent’s state that she has a huge appetite. Upon examination you find
that the patient is wheezing and you observe her coughing.
Write a differential diagnosis of at least five (5) disorders and explain
why each might be a possibility and any potential weaknesses of each
differential.
Why is it that the later in age this disease manifest itself, the less severe
the disease is?

What tests would you run to clarify your differential and potentially
come to a definitive diagnosis? If the same child was African in ancestry
would this change your initial differential? Why or why not?
Week 2: Respiratory Disorders and Alterations in Acid/Base Balance,
Fluid and Electrolytes
Discussion Part Two
(COs).
processes. (PO 1)
Tammy is a 33-year-old who presents for evaluation of a cough. She
reports that about 3 weeks ago she developed a “really bad cold” with

rhinorrhea. The cold seemed to go away but then she developed a
profound, deep, mucus-producing cough. Now, there is no rhinorrhea or
rhinitis—the primary problem is the cough. She develops these coughing
fits that are prolonged, very deep, and productive of a lot of green
sputum. She hasn’t had any fever but does have a scratchy throat.
Tammy has tried over-the-counter cough medicines but has not had
much relief. The cough keeps her awake at night and sometimes gets so
bad that she gags and dry heaves.
Write a differential of at least five (5) possible diagnosis’s and explain
how each may be a possible answer to the clinical presentation above.
Remember, to list the differential in the order of most likely to less
likely.
Based upon what you have at the top of the differential how would you
treat this patient?
Suppose now, the patient has a fever of 100.4 and complains of foul
smelling mucous and breath. Indeed, she complains of producing cups of
mucous some days. She has some trouble breathing on moderate
exertion but this is only a minor complaint to her. How does this change
your differential and why?
(COs).
Analyze pathophysiologic mechanisms associated with selected disease
states. (PO 1)
Differentiate the epidemiology, etiology, developmental considerations,
pathogenesis, and clinical and laboratory manifestations of specific
disease processes. (PO 1)

Examine the way in which homeostatic, adaptive, and compensatory
Distinguish risk factors associated with selected disease states.
Describe outcomes of disruptive or alterations in specific physiologic
processes. (PO 1)
Distinguish risk factors associated with selected disease states. (PO
Explore age-specific and developmental alterations in physiologic and
A nursing student comes into your office because they are struggling
with the concept of pulmonary function. They know you as an
experienced FNP and so they are comfortable asking if you could clarify
the terms residual volume (RV), functional reserve capacity (FRC), total
lung capacity (TLC) inspiratory reserve volume (IRV), and expiratory
reserve volume (ERV).
Give her a definition of each?
List three (3) disorders that can alter the residual volume and explain
how they do so?
**********************************
NR 507 Week 3 Discussions Cardiovascular,
Cellular, and Hematologic Disorders

Week 3: Cardiovascular, Cellular, and Hematologic Disorders
Discussion Part One
(COs).
processes. (PO 1)

disease states
A 17-year-old African American from the inner city complains of severe
chest and abdominal pain. Upon examination the attending physician
performs and EKG, chest x-ray, and an abdominal and chest clinical
examination and finds nothing. Assuming, she is drug seeking he sends
her home. She comes back to the ER 4 hours later and now you see the
patient. She explains that she was running track this past afternoon at
school and that despite being very hot (100 F) she pushed on.
Afterwards, she starts feeling extensive pain in her chest and abdomen.
She has jaundiced eyes, her blood pressure is 98/50, pulse is 112, T =
99.9 F, R = 28. The pain seems out of proportion to the physical
findings.
What is your list of differential diagnoses in this case and explain how
each of these fits with the case patient as described above. Be sure to list
at least four (4) pertinent differential diagnoses. Indicate which of these
you would select as the most likely diagnosis and explain why.
Now, as she is in the ER she begins to exhibit stroke like features. ?
Does this change your differential? How do you treat this patient now?
Are they any preventative actions that could have been taken?
Discussion Part Two
(COs).

processes. (PO 1)
Jesse is a 57-year-old male who presents with gradual onset of dyspnea
on exertion and fatigue. He also complains of frequent dyspepsia with
nausea and occasional epigastric pain. He states that at night he has
trouble breathing especially while lying on his back. This is relieved by
him sitting up. His vitals are 180/110, P = 88, T = 98.0 C, R = 20.
Write a differential in this case and explain how each item in your
differential fits and how it might not fit.
What tests would you order? What immediate treatment would you
consider giving this patient and what treatment when he went home?
Assume your first differential is definitive.
Now, he comes back to your clinic 3 months later and both his ankles
are slightly swollen. What possible explanations are there for this
observation?

(COs).
processes. (PO 1)
A new patient is brought into the office for their annual evaluation. The
child is a 6-year-old and appears a bit small for their age but not so small
that any alarm bells are set off. The vitals are: P = 116, R = 22, T = 98.6
, BP = 110/50. (The normal vitals in a 6-year-old are P = 75 – 120, R =
16 – 22, T = 98.6 , BP = (85-115)/(48-64).
Examination of the lungs is normal, HEENT is normal, as is the
abdominal exam. The heart however, seems laterally displaced and there
appears to be only a continuous murmur which can be described as
crescendo/decrescendo systolic murmur that extends into diastole.

Because, you were trained at Chamberlain College of Nursing you
immediately know that this is probably a patent ductus arteriosus.
Explain the murmur from a mechanistic view of the hearts physiological
functioning?
What is the epidemiology of a patent ductus arteriosus?
How is a patent ductus arteriosus treated?
**********************************
NR 507 Week 3 Quiz
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Quiz
Question 1.1. A 72-year-old woman with a recent onset of syncopal
episodes has been referred to a cardiology group by her family
physician. As part of the patient’s diagnostic workup, the nurse
practitioner conducting the intake assessment has ordered a Holter
monitor for 24 hours. Which of the following statements best captures
an aspect of Holter monitoring? (Points : 0.4)

A Holter monitor is preferable to standard ECG due to its increased
sensitivity to cardiac electrical activity.
The primary goal is to allow the cardiologist to accurately diagnose
cardiomyopathies.
Accurate interpretation of the results requires correlating the findings
with the activity that the woman was doing at the time of recording.
Holter monitors are normally set to record electrical activity of the heart
at least once per hour.
Question 2.2. As part of the diagnostic workup for a male patient with a
complex history of cardiovascular disease, the care team has identified
the need for a record of the electrical activity of his heart, insight into the
metabolism of his myocardium, and physical measurements, and
imaging of his heart. Which of the following series of tests is most likely
to provide the needed data for his diagnosis and care? (Points : 0.4)
Echocardiogram, PET scan, ECG
Ambulatory ECG, cardiac MRI, echocardiogram
Serum creatinine levels, chest auscultation, myocardial perfusion
scintigraphy
Cardiac catheterization, cardiac CT, exercise stress testing
Question 3.3. An 81-year-old female patient of a long-term care facility
has a history of congestive heart failure. The nurse practitioner caring
for the patient has positioned her sitting up at an angle in bed and is
observing her jugular venous distention. Why is jugular venous
distention a useful indicator for the assessment of the patient’s
condition? (Points : 0.4)
Increased cardiac demand causes engorgement of systemic blood
vessels, of which the jugular vein is one of the largest.
Blood backs up into the jugular vein because there are no valves at the
point of entry into the heart.
Peripheral dilation is associated with decreased stroke volume and
ejection fraction.
Heart valves are not capable of preventing backflow in cases of atrial
congestion.

Question 4.4. A physical assessment of a 28-year-old female patient
indicates that her blood pressure in her legs is lower than that in her
arms and that her brachial pulse is weaker in her left arm than in her
right. In addition, her femoral pulses are weak bilaterally. Which of the
following possibilities would her care provider be most likely to
suspect? (Points : 0.4)
Pheochromocytoma
Essential hypertension
Coarctation of the aorta
An adrenocortical disorder
Question 5.5. A 6-year-old boy has been brought to the emergency
department by ambulance after his mother discovered that his heart rate
was “so fast I couldn’t even count it.” The child was determined to be in
atrial flutter and his mother is seeking an explanation from the health
care team. Which of the following points should underlie an explanation
to the mother? (Points : 0.4)
The child is experiencing a reentry rhythm in his right atrium.
The resolution of the problem is dependent on spontaneous recovery and
is resistant to pacing interventions.
The child is likely to have a normal ECG apart from the rapid heart rate.
The boy’s atria are experiencing abnormal sympathetic stimulation.
Question 6.6. A 66-year-old patient’s echocardiogram reveals a
hypertrophied left ventricle, normal chamber volume, and a normal
ejection fraction from the heart. What is this patient’s most likely
diagnosis? (Points : 0.4)
Mitral valve regurgitation
Aortic valve stenosis
Mitral valve stenosis
Aortic valve regurgitation
Question 7.7. A 70-year-old male patient presents to the emergency
department complaining of pain in his calf that is exacerbated when he
walks. His pedal and popliteal pulses are faintly palpable and his leg

distal to the pain is noticeably reddened. What would his care provider’s
preliminary diagnosis and anticipated treatment most likely be?(Points :
0.4)
Acute arterial occlusion that will be treated with angioplasty
Raynaud disease that will require antiplatelet medications
Atherosclerotic occlusive disease necessitating thrombolytic therapy
Giant cell temporal arteritis that will be treated with corticosteroids
Question 8.8. A patient in the intensive care unit has a blood pressure of
87/39 and has warm, flushed skin accompanying his sudden decline in
level of consciousness. The patient also has arterial and venous dilation
and a decrease in systemic vascular resistance. What is this patient’s
most likely diagnosis? (Points : 0.4)
Hypovolemic shock
Septic shock
Neurogenic shock
Obstructive shock
Question 9.9. A 31-year-old woman with a congenital heart defect
reports episodes of lightheadedness and syncope, with occasional
palpitations. A resting electrocardiogram reveals sinus bradycardia and
she is suspected of having sick sinus syndrome. Which of the following
diagnostic methods is the best choice to investigate the suspicion?
(Points : 0.4)
Signal-averaged ECG
Exercise stress testing
Electrophysiologic study
Holter monitoring
Question 10.10. A nurse practitioner is providing care for several
patients on a medical unit of a hospital. In which of the following patient
situations would the nurse practitioner be most likely to rule out
hypertension as a contributing factor? (Points : 0.4)
A 61-year-old man who has a heart valve infection and recurrent fever

An 81-year-old woman who has had an ischemic stroke and has
consequent one-sided weakness
A 44-year-old man awaiting a kidney transplant who requires
hemodialysis three times per week
A 66-year-old woman with poorly controlled angina and consequent
limited activity tolerance
Question 11.11. A patient is experiencing impaired circulation
secondary to increased systemic arterial pressure. Which of the
following statements is the most relevant phenomenon?(Points : 0.4)
Increased preload due to vascular resistance
High afterload because of backpressure against the left ventricle
Impaired contractility due to aortic resistance
Systolic impairment because of arterial stenosis
Question 12.12. A number of patients have presented to the emergency
department in the last 24 hours with complaints that are preliminarily
indicative of myocardial infarction. Which of the following patients is
least likely to have an ST-segment myocardial infarction (STEMI)?
(Points : 0.4)
A 70-year-old woman who is complaining of shortness of breath and
vague chest discomfort
A 66-year-old man who has presented with fatigue, nausea and
vomiting, and cool, moist skin
A 43-year-old man who woke up with substernal pain that is radiating to
his neck and jaw
A 71-year-old man who has moist skin, fever, and chest pain that is
excruciating when he moves but relieved when at rest
Question 13.13. A formerly normotensive woman, pregnant for the first
time, develops hypertension and headaches at 26 weeks’ gestation. Her
blood pressure is 154/110 mm Hg and she has proteinuria. What other
labs should be ordered for her? (Points : 0.4)
Plasma angiotensin I and II and renin
Urinary sodium and potassium

Platelet count, serum creatinine, and liver enzymes
Urinary catecholamines and metabolites
Question 14.14. An older adult female patient has presented with a new
onset of shortness of breath, and the patient’s nurse practitioner has
ordered measurement of her BNP levels along with other diagnostic
tests. What is the most accurate rationale for the nurse practitioner’s
choice of blood work? (Points : 0.4)
BNP is released as a compensatory mechanism during heart failure and
measuring it can help differentiate the patient’s dyspnea from a
respiratory pathology.
BNP is an indirect indicator of the effectiveness of the RAA system in
compensating for heart failure.
BNP levels correlate with the patient’s risk of developing cognitive
deficits secondary to heart failure and consequent brain hypoxia.
BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes
respirations, and acute pulmonary edema, and measurement can gauge
the severity of pulmonary effects.
Question 15.15. The nurse practitioner for a cardiology practice is
responsible for providing presurgical teaching for patients who are about
to undergo a coronary artery bypass graft. Which of the following
teaching points best conveys an aspect of the human circulatory system?
(Points : 0.4)
“Your blood pressure varies widely between arteries and veins, and
between pulmonary and systemic circulation.”
“Only around one quarter of your blood is in your heart at any given
time.”
“Blood pressure and blood volume roughly mimic one another at any
given location in the circulatory system.”
“Left-sided and right-sided pumping action at each beat of the heart
must equal each other to ensure adequate blood distribution.”
Question 16.16. A 54-year-old man with a long-standing diagnosis of
essential hypertension is meeting with his nurse practitioner. The

patient’s nurse practitioner would anticipate that which of the following
phenomena is most likely occurring? (Points : 0.4)
The patient’s juxtaglomerular cells are releasing aldosterone as a result
of sympathetic stimulation.
Epinephrine from his adrenal gland is initiating the renin-angiotensin-
aldosterone system.
Vasopressin is exerting an effect on his chemoreceptors and
baroreceptors, resulting in vasoconstriction.
The conversion of angiotensin I to angiotensin II in his lungs causes
increases in blood pressure and sodium reabsorption.
Question 17.17. A 22-year-old male is experiencing hypovolemic shock
following a fight in which his carotid artery was cut with a broken
bottle. What immediate treatments are likely to most benefit the man?
(Points : 0.4)
Resolution of compensatory pulmonary edema and heart arrhythmias
Infusion of vasodilators to foster perfusion and inotropes to improve
heart contractility
Infusion of normal saline of Ringer lactate to maintain the vascular
space
Administration of oxygen and epinephrine to promote perfusion
Question 18.18. A 66-year-old obese man with a diagnosis of ischemic
heart disease has been diagnosed with heart failure that his care team has
characterized as attributable to systolic dysfunction. Which of the
following assessment findings is inconsistent with his diagnosis? (Points
: 0.4)
His resting blood pressure is normally in the range of 150/90 and an
echocardiogram indicates his ejection fraction is 30%.
His end-diastolic volume is higher than normal and his resting heart rate
is regular and 82 beats per minute.
He is presently volume overloaded following several days of intravenous
fluid replacement.
Ventricular dilation and wall tension are significantly lower than normal.

Question 19.19. A 68-year-old male complains to his nurse practitioner
that when he tests his blood pressure using a machine at his pharmacy,
his heart rate is nearly always very low. At other times, he feels that his
heart is racing, and it also seems to pause at times. The man has also
occasionally had lightheadedness and a recent syncopal episode. What is
this patient’s most likely diagnosis and the phenomenon underlying it?
(Points : 0.4)
Sick sinus syndrome as a result of a disease of his sinus node and atrial
or junctional arrhythmias
Ventricular arrhythmia as a result of alternating vagal and sympathetic
stimulation
Torsades de pointes as a result of disease of the bundle of His
Premature atrial contractions that vacillate between tachycardic and
bradycardic episodes as a consequence of an infectious process
Question 20.20. An autopsy is being performed on a 44-year-old female
who died unexpectedly of heart failure. Which of the following
components of the pathologist’s report is most suggestive of a possible
history of poorly controlled blood pressure? (Points : 0.4)
“Scarring of urethra suggestive of recurrent urinary tract infections is
evident.”
“Bilateral renal hypertrophy noted.”
“Vessel wall changes suggestive of venous stasis are evident.”
“Arterial sclerosis of subcortical brain regions noted.”
Question 21.21. During a routine physical examination of a 66-year-old
woman, her nurse practitioner notes a pulsating abdominal mass and
refers the woman for further treatment. The nurse practitioner is
explaining the diagnosis to the patient, who is unfamiliar with
aneurysms.Which of the following aspects of the pathophysiology of
aneurysms would underlie the explanation the nurse provides? (Points :
0.4)
Aneurysms are commonly a result of poorly controlled diabetes mellitus.
Hypertension is a frequent modifiable contributor to aneurysms.

Individuals with an aneurysm are normally asymptomatic until the
aneurysm ruptures.
Aneurysms can normally be resolved with lifestyle and diet
modifications.
Question 22.22. A patient has suffered damage to his pericardium
following a motor vehicle accident. Which of the following
consequences should the nurse practitioner be most likely to rule out?
(Points : 0.4)
Impaired physical restraint of the left ventricule
Increased friction during the contraction/relaxation cycle
Reduced protection from infectious organisms
Impaired regulation of myocardial contraction
Question 23.23. A nurse practitioner is instructing a group of older
adults about the risks associated with high cholesterol. Which of the
following teaching points should the participants try to integrate into
their lifestyle after the teaching session? (Points : 0.4)
“Remember, the ‘H’ in HDL and the ‘L’ in LDL correspond to high
danger and low danger to your health.”
“Having high cholesterol increases your risk of developing diabetes and
irregular heart rate.”
“Smoking and being overweight increases your risk of primary
hypercholesterolemia.”
“Your family history of hypercholesterolemia is important, but there are
things you can do to compensate for a high inherited risk.”
Question 24.24. An 81-year-old male resident of a long-term care
facility has a long-standing diagnosis of heart failure. Which of the
following short-term and longer-term compensatory mechanisms is least
likely to decrease the symptoms of his heart failure? (Points : 0.4)
An increase in preload via the Frank-Starling mechanism
Sympathetic stimulation and increased serum levels of epinephrine and
norepinephrine

Activation of the renin-angiotensin-aldosterone (RAA) system and
secretion of brain natriuretic peptide (BNP)
AV node pacemaking activity and vagal nerve suppression
Question 25.25. A 55-year-old male who is beginning to take a statin
drug for his hypercholesterolemia is discussing cholesterol and its role in
health and illness with his nurse practitioner. Which of the following
aspects of hyperlipidemia would the nurse practitioner most likely take
into account when teaching the patient? (Points: 0.4)
Hyperlipidemia is a consequence of diet and lifestyle rather than
genetics.
HDL cholesterol is often characterized as being beneficial to health.
Cholesterol is a metabolic waste product that the liver is responsible for
clearing.
The goal of medical treatment is to eliminate cholesterol from the
vascular system.
1. A nurse practitioner is teaching a student NP about the physiologic
basis for damage to the circulatory and neurological systems that can
accompany hypotension. Which of the following responses by the
student would warrant correction by the nurse practitioner? (Points : 0.4)
“As vessel wall thickness increases, tension decreases.”
“Smaller blood vessels require more pressure to overcome wall tension.”
“The smaller the vessel radius, the greater the pressure needed to keep it
open.”
“Tension and vessel thickness increase proportionately.”
Question 2.2. A 31-year-old woman with a congenital heart defect
reports episodes of lightheadedness and syncope, with occasional
palpitations.A resting electrocardiogram reveals sinus bradycardia and
she is suspected of having sick sinus syndrome. Which of the following
diagnostic methods is the best choice to investigate the suspicion?
(Points: 0.4)
Signal-averaged ECG
Exercise stress testing

Electrophysiologic study
Holter monitoring
Question 3.3. Which of the following assessment findings in a newly
admitted 30-year-old male patient would be most likely to cause his
nurse practitioner to suspect polyarteritis nodosa? (Points : 0.4)
The man’s blood work indicates polycythemia (elevated red cells levels)
and leukocytosis (elevated white cells).
The man’s blood pressure is 178/102 and he has abnormal liver function
tests.
The man is acutely short of breath and his oxygen saturation is 87%.
The man’s temperature is 101.9°F and he is diaphoretic (heavily
sweating).
Question 4.4. An 81-year-old male resident of a long-term care facility
has a long-standing diagnosis of heart failure. Which of the following
short-term and longer-term compensatory mechanisms is least likely to
decrease the symptoms of his heart failure? (Points : 0.4)
An increase in preload via the Frank-Starling mechanism
Sympathetic stimulation and increased serum levels of epinephrine and
norepinephrine
Activation of the renin-angiotensin-aldosterone (RAA) system and
secretion of brain natriuretic peptide (BNP)
AV node pacemaking activity and vagal nerve suppression
Question 5.5. A nurse practitioner is instructing a group of older adults
about the risks associated with high cholesterol. Which of the following
teaching points should the participants try to integrate into their lifestyle
after the teaching session? (Points : 0.4)
“Remember, the ‘H’ in HDL and the ‘L’ in LDL correspond to high
danger and low danger to your health.”
“Having high cholesterol increases your risk of developing diabetes and
irregular heart rate.”
“Smoking and being overweight increases your risk of primary
hypercholesterolemia.”

“Your family history of hypercholesterolemia is important, but there are
things you can do to compensate for a high inherited risk.”
Question 6.6. A 55-year-old male who is beginning to take a statin drug
for his hypercholesterolemia is discussing cholesterol and its role in
health and illness with his nurse practitioner. Which of the following
aspects of hyperlipidemia would the nurse practitioner most likely take
into account when teaching the patient? (Points : 0.4)
Hyperlipidemia is a consequence of diet and lifestyle rather than
genetics.
HDL cholesterol is often characterized as being beneficial to health.
Cholesterol is a metabolic waste product that the liver is responsible for
clearing.
The goal of medical treatment is to eliminate cholesterol from the
vascular system.
Question 7.7. A number of patients have presented to the emergency
department in the last 24 hours with complaints that are preliminarily
indicative of myocardial infarction. Which of the following patients is
least likely to have an ST-segment myocardial infarction (STEMI)?
(Points : 0.4)
A 70-year-old woman who is complaining of shortness of breath and
vague chest discomfort
A 66-year-old man who has presented with fatigue, nausea and
vomiting, and cool, moist skin
A 43-year-old man who woke up with substernal pain that is radiating to
his neck and jaw
A 71-year-old man who has moist skin, fever, and chest pain that is
excruciating when he moves but relieved when at rest
Question 8.8. A patient in the intensive care unit has a blood pressure of
87/39 and has warm, flushed skin accompanying his sudden decline in
level of consciousness. The patient also has arterial and venous dilation
and a decrease in systemic vascular resistance. What is this patient’s
most likely diagnosis? (Points : 0.4)

Hypovolemic shock
Septic shock
Neurogenic shock
Obstructive shock
Question 9.9. A formerly normotensive woman, pregnant for the first
time, develops hypertension and headaches at 26 weeks’ gestation. Her
blood pressure is 154/110 mm Hg and she has proteinuria. What other
labs should be ordered for her? (Points : 0.4)
Plasma angiotensin I and II and renin
Urinary sodium and potassium
Platelet count, serum creatinine, and liver enzymes
Urinary catecholamines and metabolites
Question 10.10. An older adult female patient has presented with a new
onset of shortness of breath, and the patient’s nurse practitioner has
ordered measurement of her BNP levels along with other diagnostic
tests. What is the most accurate rationale for the nurse practitioner’s
choice of blood work? (Points : 0.4)
BNP is released as a compensatory mechanism during heart failure and
measuring it can help differentiate the patient’s dyspnea from a
respiratory pathology.
BNP is an indirect indicator of the effectiveness of the RAA system in
compensating for heart failure.
BNP levels correlate with the patient’s risk of developing cognitive
deficits secondary to heart failure and consequent brain hypoxia.
BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes
respirations, and acute pulmonary edema, and measurement can gauge
the severity of pulmonary effects.
Question 11.11. A nurse practitioner has ordered the measurement of a
cardiac patient’s electrolyte levels as part of the patient’s morning blood
work. Which of the following statements best captures the importance of
potassium in the normal electrical function of the patient’s heart? (Points
: 0.4)

Potassium catalyzes the metabolism of ATP, producing the gradient that
results in electrical stimulation.
Potassium is central to establishing and maintaining the resting
membrane potential of cardiac muscle cells.
The impermeability of cardiac cell membranes to potassium allows for
action potentials achieved by the flow of sodium ions.
The reciprocal movement of one potassium ion for one sodium ion
across the cell membrane results in the production of an action potential.
Question 12.12. A 70-year-old male patient presents to the emergency
department complaining of pain in his calf that is exacerbated when he
walks. His pedal and popliteal pulses are faintly palpable and his leg
distal to the pain is noticeably reddened. What would his care provider’s
preliminary diagnosis and anticipated treatment most likely be? (Points :
0.4)
Acute arterial occlusion that will be treated with angioplasty
Raynaud disease that will require antiplatelet medications
Atherosclerotic occlusive disease necessitating thrombolytic therapy
Giant cell temporal arteritis that will be treated with corticosteroids
Question 13.13. Which of the following situations related to the
transition from fetal to perinatal circulation would be most likely to
necessitate medical intervention? (Points : 0.4)
Pressure in the pulmonary circulation and the right side of the infant’s
heart fall markedly.
Alveolar oxygen tension increases, causing reversal of pulmonary
vasoconstriction of the fetal arteries.
Systemic vascular resistance and left ventricular pressure are both
increasing.
Pulmonary vascular resistance, related to muscle regression in the
pulmonary arteries, rises over the course of the infant’s first week.
Question 14.14. In which of the following patient situations would a
nurse practitioner be most justified in preliminarily ruling out
pericarditis as a contributing pathology to the patient’s health problems?
(Points : 0.4)

A 61-year-old man whose ECG was characterized by widespread T
wave inversions on admission but whose T waves have recently
normalized
A 77-year-old with diminished S3 and S4 sounds, an irregular heart rate,
and a history of atrial fibrillation
A 56-year-old obese man who is complaining of chest pain that is
exacerbated by deep inspiration and is radiating to his neck and scapular
ridge
A 60-year-old woman whose admission blood work indicates elevated
white cells, erythrocyte sedimentation rate, and C-reactive protein levels
Question 15.15. During a routine physical examination of a 66-year-old
woman, her nurse practitioner notes a pulsating abdominal mass and
refers the woman for further treatment. The nurse practitioner is
explaining the diagnosis to the patient, who is unfamiliar with
aneurysms. Which of the following aspects of the pathophysiology of
aneurysms would underlie the explanation the nurse provides? (Points :
0.4)
Aneurysms are commonly a result of poorly controlled diabetes mellitus.
Hypertension is a frequent modifiable contributor to aneurysms.
Individuals with an aneurysm are normally asymptomatic until the
aneurysm ruptures.
Aneurysms can normally be resolved with lifestyle and diet
modifications.
Question 16.16. A patient is experiencing impaired circulation
secondary to increased systemic arterial pressure. Which of the
following statements is the most relevant phenomenon?(Points : 0.4)
Increased preload due to vascular resistance
High afterload because of backpressure against the left ventricle
Impaired contractility due to aortic resistance
Systolic impairment because of arterial stenosis
Question 17.17. A 66-year-old patient’s echocardiogram reveals a
hypertrophied left ventricle, normal chamber volume, and a normal

ejection fraction from the heart. What is this patient’s most likely
diagnosis? (Points : 0.4)
Mitral valve regurgitation
Aortic valve stenosis
Mitral valve stenosis
Aortic valve regurgitation
Question 18.18. A physical assessment of a 28-year-old female patient
indicates that her blood pressure in her legs is lower than that in her
arms and that her brachial pulse is weaker in her left arm than in her
right. In addition, her femoral pulses are weak bilaterally. Which of the
following possibilities would her care provider be most likely to
suspect? (Points : 0.4)
Pheochromocytoma
Essential hypertension
Coarctation of the aorta
An adrenocortical disorder
Question 19.19. A 72-year-old woman with a recent onset of syncopal
episodes has been referred to a cardiology group by her family
physician. As part of the patient’s diagnostic workup, the nurse
practitioner conducting the intake assessment has ordered a Holter
monitor for 24 hours.Which of the following statements best captures an
aspect of Holter monitoring? (Points: 0.4)
A Holter monitor is preferable to standard ECG due to its increased
sensitivity to cardiac electrical activity.
The primary goal is to allow the cardiologist to accurately diagnose
cardiomyopathies.
Accurate interpretation of the results requires correlating the findings
with the activity that the woman was doing at the time of recording.
Holter monitors are normally set to record electrical activity of the heart
at least once per hour.
Question 20.20. An 81-year-old female patient of a long-term care
facility has a history of congestive heart failure. The nurse practitioner

caring for the patient has positioned her sitting up at an angle in bed and
is observing her jugular venous distention. Why is jugular venous
distention a useful indicator for the assessment of the patient’s
condition? (Points : 0.4)
Increased cardiac demand causes engorgement of systemic blood
vessels, of which the jugular vein is one of the largest.
Blood backs up into the jugular vein because there are no valves at the
point of entry into the heart.
Peripheral dilation is associated with decreased stroke volume and
ejection fraction.
Heart valves are not capable of preventing backflow in cases of atrial
congestion.
Question 21.21. As part of the diagnostic workup for a male patient with
a complex history of cardiovascular disease, the care team has identified
the need for a record of the electrical activity of his heart, insight into the
metabolism of his myocardium, and physical measurements, and
imaging of his heart. Which of the following series of tests is most likely
to provide the needed data for his diagnosis and care? (Points : 0.4)
Echocardiogram, PET scan, ECG
Ambulatory ECG, cardiac MRI, echocardiogram
Serum creatinine levels, chest auscultation, myocardial perfusion
scintigraphy
Cardiac catheterization, cardiac CT, exercise stress testing
Question 22.22. A 6-year-old boy has been brought to the emergency
department by ambulance after his mother discovered that his heart rate
was “so fast I couldn’t even count it.” The child was determined to be in
atrial flutter and his mother is seeking an explanation from the health
care team. Which of the following points should underlie an explanation
to the mother? (Points: 0.4)
The child is experiencing a reentry rhythm in his right atrium.
The resolution of the problem is dependent on spontaneous recovery and
is resistant to pacing interventions.

The child is likely to have a normal ECG apart from the rapid heart rate.
The boy’s atria are experiencing abnormal sympathetic stimulation.
Question 23.23. A 66-year-old obese man with a diagnosis of ischemic
heart disease has been diagnosed with heart failure that his care team has
characterized as attributable to systolic dysfunction. Which of the
following assessment findings is inconsistent with his diagnosis? (Points
: 0.4)
His resting blood pressure is normally in the range of 150/90 and an
echocardiogram indicates his ejection fraction is 30%.
His end-diastolic volume is higher than normal and his resting heart rate
is regular and 82 beats per minute.
He is presently volume overloaded following several days of intravenous
fluid replacement.
Ventricular dilation and wall tension are significantly lower than normal.
Question 24.24. A 54-year-old man with a long-standing diagnosis of
essential hypertension is meeting with his nurse practitioner. The
patient’s nurse practitioner would anticipate that which of the following
phenomena is most likely occurring? (Points : 0.4)
The patient’s juxtaglomerular cells are releasing aldosterone as a result
of sympathetic stimulation.
Epinephrine from his adrenal gland is initiating the renin-angiotensin-
aldosterone system.
Vasopressin is exerting an effect on his chemoreceptors and
baroreceptors, resulting in vasoconstriction.
The conversion of angiotensin I to angiotensin II in his lungs causes
increases in blood pressure and sodium reabsorption.
Question 25.25. The nurse practitioner for a cardiology practice is
responsible for providing presurgical teaching for patients who are about
to undergo a coronary artery bypass graft. Which of the following
teaching points best conveys an aspect of the human circulatory system?
(Points : 0.4)

“Your blood pressure varies widely between arteries and veins, and
between pulmonary and systemic circulation.”
“Only around one quarter of your blood is in your heart at any given
time.”
“Blood pressure and blood volume roughly mimic one another at any
given location in the circulatory system.”
“Left-sided and right-sided pumping action at each beat of the heart
must equal each other to ensure adequate blood distribution.”
Winland-Brown, J.E. and Dunphy, L.M. (2013). Adult-Gerontology and
Family Nurse Practitioner Certification Examination: Review Questions
and Strategies.
Codina Leik, M.T. (2013). Adult-Gerotonolgy Nurse Practitioner
Certification Intensive Review: Fast Facts and Practice Questions. 2ND
Ed.
**********************************
NR 507 Week 4 Discussions Alterations in Renal
Function
Week 4: Alterations in Renal Function
Discussion Part One

(COs).
processes. (PO 1)
Mrs. Orndorf is a 28-year-old woman married for 3 years who has just
returned from an outdoor camping trip with her husband, with symptoms
of dysuria with a burning sensation, urgency to urinate, and frequent
urination. She said, “I have had similar symptoms three times over the
last 2 years. Pubic and low back discomfort awoke me two nights ago
and that is why I am here.” On physical examination, her temperature
was 98.6° F, blood pressure was 114/64 mm Hg, pulse was 68 beats per
minute, and the respiratory rate was 12 breaths per minute. Other than a
tender abdominal pelvic area, the examination was unremarkable.

• What is your list of differential diagnoses in this case and explain how
each of these fits with the case patient as described above. Be sure to list
at least four (4) pertinent differential diagnoses. Indicate which of these
you would select as the most likely diagnosis and explain why.
• According to the first item in your differential, what are the risk factors
for this disorder?
• What are some treatments for this disorder?
Discussion Part Two
(COs).
processes. (PO 1)

A 56-year-old female comes into the clinic complaining of intermittent
severe pain that radiates from the flank to the groin and sometimes to the
inner thigh. Upon further questioning she tell you that she has an urge to
always go to the restroom and that she sometime sweats and feels
nauseous. A urinalysis provides traces of blood, a few white blood cells
and no bacteria.
• What is your differential diagnosis? Discuss in detail the
pathophysiology of each item in your differential and how it might fit in
describing this case.
• The x-ray comes back and there is nothing abnormal except a slightly
dilated ureter. Does this change your differential or narrow it?
• How would you treat the pain in this case?
(COs).

processes. (PO 1)
A 60-year-old patient comes into your office with a history of
hypertension and a myocardial infarction 13 years ago. You notice that
both of her ankles are swollen and that her skin seems shiny. She first
noticed her ankle swelling 9 months ago and it has gotten progressively
worse. She has a smell of ammonia on her. She also has a 2 year history
of diabetes.
• What are at least five systemic effects of chronic kidney disease?
• How would you modify the diet and what is the rationale to the
changes of the diet that you make?
**********************************
NR 507 Week 5 Discussions Alterations in
Endocrine Function

Week 5: Alterations in Endocrine Function
Discussion Part One
(COs).
processes. (PO 1)
Ms. Blake is an older adult with diabetes and has been too ill to get out
of bed for 2 days. She has had a severe cough and has been unable to eat
or drink during this time. She has a history of Type I diabetes. On
admission her laboratory values show:

Sodium (Na+) 156 mEq/L
Potassium (K+) 4.0 mEq/L
Chloride (Cl–) 115 mEq/L
Arterial blood gases (ABGs) pH- 7.30; Pco2-40; Po2-70; HCO3-20
Normal values Sodium (Na+) 136-146 mEq/L
Potassium (K+) 3.5-5.1 mEq/L
Chloride (Cl–) 98-106 mEq/L
Arterial blood gases (ABGs) pH- 7.35-7.45
Pco2- 35-45 mmHg
Po2-80-100 mmHg
HCO3–22-28 mEq/L
• List five (5) reasons on why she may have become bed ridden?
• Based on these reasons what tests would you order?
• Describe the molecular mechanism of the development of ketoacidosis.
Discussion Part Two
(COs).

processes. (PO 1)
disease states
A three-month-old baby boy comes into your clinic with the main
complaint that he frequently vomits after eating. He often has a swollen
upper belly after feeding and acts fussy all the time. The vomiting has
become more frequent this past week and he is beginning to lose weight.
• What is your differential diagnosis at this time?
• Is there any genetic component to the top of your differential?
• What tests would you order?
(COs).

processes. (PO 1)
Write a one (1) paragraph case study of your own for a patient with
Ulcerative Colitis?
**********************************
NR 507 Week 6 Discussions Dermatologic and
Musculoskeletal Disorders

Week 6: Dermatologic and Musculoskeletal Disorders
Discussion Part One
(COs).
processes. (PO 1)
disease states
You are contacted by an attorney representing a client who has been
charged with child abuse and whom faces loss of her child and 15 years

in prison. The record indicated that the child was 4 years old and
presented to the ER room with a broken arm and a broken leg There also
appeared to be multiple previous fractures. Now, you examine the child
and find blue sclera, a sunken chest wall, severe scoliosis, and you
observe a triangular face and prominent forehead. You confirm that
there have been multiple previous fractures by evaluating the previous
X-rays. This is a genetic disorder.
• What is the most likely genetic disease that this presents and why?
• What is the molecular basis of this disease?
• Before, calling the police what should the initial clinician have done?
Discussion Part Two
(COs).
processes. (PO 1)

Johnny is a 5-year-old Asian boy who is brought to a family practice
office with a “runny” nose that started about 1 week ago but has not
resolved. He has been blowing his nose quite frequently and “sores”
have developed around his nose. His mother states, “The sores started as
‘big blisters’ that rupture; sometimes, a scab forms with a crust that
looks like “dried maple syrup” but continues to seep and drain.” She is
worried because the lesions are now also on his forearm. Johnny’s past
medical and family histories are normal. He has been febrile but is
otherwise asymptomatic. The physical examination was unremarkable
except for moderate, purulent rhinorrhea and 0.5- to 1-cm diameter
weeping lesions around the nose and mouth and on the radial surface of
the right forearm. There is no regional lymphadenopathy.
• Write a differential of at least five (5) possible diagnosis’s and explain
how each may be a possible answer to the clinical presentation above.
Remember, to list the differential in the order of most likely to less
likely.
• Based upon what you have at the top of the differential how would you
treat this patient? Differential diagnosis for this clinical presentation and
justify it.
• When would you allow the student back to school? Elaborate on your
reasoning?
Keisha, a 13-year-old female, has come into your urgent care center. She
has red conjunctiva, a cough and a fever of about 104 0C, She also has a

rash on her face a possibly the beginning of a rash on her arms. About
10 days ago she was around another student who had similar symptoms.
• What is the differential diagnosis?
• What are some of the complications of this disease, assume that the top
of your differential is the definitive?
• Assume that the second item you place on your differential is the
definitive diagnosis. What are some complications of that disease?
**********************************
NR 507 Week 7 Discussions Behavioral,
Neurologic, and Digestive Disorders
Week 7: Behavioral, Neurologic, and Digestive Disorders
Discussion Part One
(COs).

processes. (PO 1)
You are at the local mall and you see a patient who appears to be
homeless by his physical appearance and you witness the person “walk
50 feet to a table sit down, and after 5 seconds he gets up and walks to a
tree and urinates on it” He repeats this action 5 times apparently
oblivious to his surroundings. When the police come he ignores them as
if they aren’t there. Later, you go to work and sitting in exam room 3 is
the same person! Now, he is your patient, when you talk to him he has
no recollection of his behavior by the mall.
• What is your differential diagnosis?
• What tests do you order?

• An MRI comes back and there seems to be a lesion in the temporal
lobe does this change your differential? The EEG also comes back with
unusual excitatory activity. What is your definitive diagnosis? In
retrospect did anything bias your first differential?
Discussion Part Two
Your patient is a 77-year-old woman who has been more socially
withdrawn lately and told her daughter she had not been feeling well.
Her daughter has noticed a stepwise decline. While shopping for
groceries with her daughter she became separated from daughter in the
aisles. She became confused and angry when store employees and others
tried to assist her. Her current medications are Hydrochlorothiazide,
Lisinopril and Atorvastatin.
• What is your differential diagnosis based on the information you now
have?
• What other questions would you like to ask her now? (Questions can
be asked of patient first, and then of reliable historian separately.)
• How would you treat this patient and discuss why you give each
medication or therapy you give.

processes. (PO 1)
A 19-year-old freshman in college has been brought to your office by
campus security. The patient had been standing on top of the school
chapel proclaiming that he was the prophet of God and that God was
speaking to him. In fact he claimed to actually hear God’s voice. When
he is in your office you notice that he is speaking very fast, can’t seem to
sit still and his sentences at times don’t seem to make sense. He states, “I
saw the professor sit on the ham sandwich and eat the raw calculus in his
mind”
• What is your differential diagnosis, how does it fit how might it not fit?
• Based on the top of your differential what is the epidemiology of that
disorder?
**********************************

NR 507 Week 8 Discussions Genomes, Genetic
Alterations, and Reproductive Disorders
Reflection
Week 8: Genomes, Genetic Alterations, and Reproductive Disorders
Reflection
Reflect on personal and professional growth toward achieving
competence as a family nurse practitioner. (PO 5, 10)
Reflect back over the past eight weeks and describe how the
achievement of the course outcomes in this course have prepared you to
meet the MSN program outcome #, MSN Essential VIII, and Nurse
Practitioner Core Competencies # 1 Scientific Foundation Competencies
Program Outcome #4: Evaluate the design, implementation, and
outcomes of strategies developed to meet healthcare needs (MSN
Essentials III, IV, VIII). MSN Essential VIII: Clinical Prevention and
Population Health for Improving Health
•Recognizes that the master’s-prepared nurse applies and integrates
broad, organizational, client-centered, and culturally appropriate
concepts in the planning, delivery, management, and evaluation of

evidence-based clinical prevention and population care and services to
individuals, families, and aggregates/identified populations.
Nurse Practitioner Core Competencies # 1 Scientific Foundation
Competencies
1. Critically analyzes data and evidence for improving advanced nursing
practice.
2. Integrates knowledge from the humanities and sciences within the
context of nursing science.
3. Translates research and other forms of knowledge to improve practice
processes and outcomes.
4. Develops new practice approaches based on the integration of
research, theory, and practice knowledge.
**********************************

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