36402 Topic: HA19 W7R2 Number of Pages: 1 (Double Spaced) Number of sources: 2 Writing Style: APA Type of document: Essay Academic Level:Master Category: Nursing Language Style: English (U.S.) Order Instructions: ATTACHED Manage Discussion Entry The first question I would ask this patient would be if she performs regular breast exams and how often, this can provide a reference point as to how long the lump has been present. Second I would ask for a detailed history of any family breast cancer along with more personal information such as her onset of menarche, is she on any hormone replacement therapy or has she even been, also has she breast fed or is she currently breastfeeding. Lastly is there any type of nipple discharge and if so what color, this can provide a good indication as to whether the lump may be benign or not. A palpable breast mass is a potentially frightening finding for a woman. The media has widely disseminated the statistic that 1 in 8 women will have breast cancer in their lifetime (Sabel,2015) . Fortunately, most palpable breast masses are not cancerous. Unfortunately, a definitive determination of whether a lesion is benign or malignant cannot be made by history and physical examination findings only. Certain factors have been identified as increasing a woman's risk of breast cancer. A family history of breast cancer in a first-degree relative (parent, sibling), especially if the cancer occurred in a premenopausal woman and was bilateral. is associated with an increased risk. Early age at menarche (<12 years), late age of menopause (>55 years), and nulliparity or first live birth after the age of 30 years are also associated with higher risks. The use of hormones, either estrogen alone or combined with progesterone, are considered to confer higher risks, although recent studies raise some questions and further information is needed. Lifestyle considerations, including obesity, physical inactivity, and alcohol use (>3 drinks per day), also are identified risk factors. Finally, a history of previous breast disease, especially biopsies showing atypical hyperplasia, carcinoma in situ, or prior breast cancer, are associated with increased risks (ICSI,2016). In this case, there are several pieces of information presented that lead toward a likelihood of a benign process. Breast cancer can occur at any age. but approximately 70% of breast cancers occur in women older than age 50 years. You can never overlook the possibility of malignancy in a woman who is in her 30s, but the possibility of cancer is lower in her than in an older woman. The characteristics of the lesion are also more consistent with a benign, probably cystic, process. It is described as well-circumscribed, firm, mobile, tender, and with no overlying skin changes( Sabel, 2015). Lesions that are hard, fixed in place, non tender. have indistinct borders, or have overlying skin dimpling/retraction arc more suggestive of cancer. Nevertheles.

1. 36402 Topic: HA19 W7R2
Number of Pages: 1 (Double Spaced)
Number of sources: 2
Writing Style: APA
Type of document: Essay
Academic Level:Master
Category: Nursing
Language Style: English (U.S.)
Order Instructions: ATTACHED
Manage Discussion Entry
The first question I would ask this patient would be if she
performs regular breast exams and how often, this can provide a
reference point as to how long the lump has been present.
Second I would ask for a detailed history of any family breast
cancer along with more personal information such as her onset
of menarche, is she on any hormone replacement therapy or has
she even been, also has she breast fed or is she currently
breastfeeding. Lastly is there any type of nipple discharge and if
so what color, this can provide a good indication as to whether
the lump may be benign or not.

2. A palpable breast mass is a potentially frightening finding for a
woman. The media has widely disseminated the statistic that 1
in 8 women will have breast cancer in their lifetime
(Sabel,2015) . Fortunately, most palpable breast masses are not
cancerous. Unfortunately, a definitive determination of whether
a lesion is benign or malignant cannot be made by history and
physical examination findings only.
Certain factors have been identified as increasing a woman's
risk of breast cancer. A family history of breast cancer in a
first-degree relative (parent, sibling), especially if the cancer
occurred in a premenopausal woman and was bilateral. is
associated with an increased risk. Early age at menarche (<12
years), late age of menopause (>55 years), and nulliparity or
first live birth after the age of 30 years are also associated with
higher risks. The use of hormones, either estrogen alone or
combined with progesterone, are considered to confer higher
risks, although recent studies raise some questions and further
information is needed. Lifestyle considerations, including
obesity, physical inactivity, and alcohol use (>3 drinks per day),
also are identified risk factors. Finally, a history of previous
breast disease, especially biopsies showing atypical hyperplasia,
carcinoma in situ, or prior breast cancer, are associated with
increased risks (ICSI,2016).
In this case, there are several pieces of information presented
that lead toward a likelihood of a benign process. Breast cancer
can occur at any age. but approximately 70% of breast cancers
occur in women older than age 50 years. You can never
overlook the possibility of malignancy in a woman who is in her
30s, but the possibility of cancer is lower in her than in an older

3. woman. The characteristics of the lesion are also more
consistent with a benign, probably cystic, process. It is
described as well-circumscribed, firm, mobile, tender, and with
no overlying skin changes( Sabel, 2015). Lesions that are hard,
fixed in place, non tender. have indistinct borders, or have
overlying skin dimpling/retraction arc more suggestive of
cancer. Nevertheless, no individual characteristic on
examination is diagnostic and an appropriate evaluation is
necessary.
Sabel M. Advances in breast cancer detection and management.
Med Clin North Am 2015:87:997-1028.
Institute for Clinical Systems Improvement. Diagnosis of breast
disease. Bloomington,MN: Institute for Clinical Systems
Improvement. 2016:1-51.
** Provide response writing with references. All references
must be in APA format and published within the last 5 years.
Problems facing Government:
Healthcare and National Security
Gayward Smith

4. American Government
February 24, 2019
Dr. Herma Percy
INTRODUCTION
Federal government is responsible for the general welfare and
safety of the public.
This can be seen in Healthcare Reform and National Security.
Both represent a social concern and an issue to be addressed
through law and policy.
Examining the problems impacting healthcare and national
security, solutions can be provided to improve the wellbeing
and continuity of the nation.
HEALTHCARE
As many as 28 million Americans have no medical coverage,
(Berchick, 2017);
This represents about 10% of the U.S population;
The majority are working class adults between the ages of 25
and 45;
12% of the uninsured are children;
Addressing the issue of healthcare is a key concern for both
citizens and policymakers.
HEALTHCARE
PROBLEM
The Affordable Care Act (ACA) or Obamacare was passed in

5. 2010.
It gave those living below poverty access to medical insurance;
Ensured preexisting medical conditions did not impact pay and
policy;
Expanded Medicaid, preventive care, mental health, and
substance abuse coverage.
In 2016. the Trump administration created barriers and
limitations to ACA to address problems:
individual mandates,
weak subsidies,
incentives for insurers and buyers,
limited access to care.
HEALTHCARE
Maintain ACA original framework
All households pay a cap of 8.5% to medical coverage,
introduced by Sen. Warren.
Add public options to the ACA to reduce rates, introduced by
Sen. Sanders.
Replace ACA with healthcare reform to sale insurance across
states, deduct health premiums from tax returns, and block
grants to Medicad, introduced by Pres. Trump
SOLUTIONS
Proposals and actions demonstrated by Executive and
Legislative branch are unviable and does little to address the
issue of uninsured Americans.
Proposals presented by party minorities provides solutions to a
growing problem.
However, the best way to address this issue is through
collaboration.

6. This requires “strong leadership, a clear direction, and
consistent policies to raise the level of quality for programs and
improve the healthcare sector”, (Corrigan, Eden, & Smith,
2003).
HEALTHCARE
RECOMMENDATION
“Framers of the Constitution viewed the security of the nation
to be the foremost responsibility of the federal government”,
(Meese, 2011).
The President holds the highest power with full executive
authority as commander and chief to manage and create security
departments.
Congress primary responsibility to national security is to
funding national security measures.
Departments of national security include, ICE, Coast Guard,
Transportation Security Administration, DHS, and others.
NATIONAL SECURITY
According to the Homeland Security Digital Library there are
impending threats to National Security that include the
following:
China and Russia expansion
Iran and North Korea military developments
Terrorism
Artificial intelligence and biotechnology
Weapons of mass destruction
Climate change, (2019)
NATIONAL SECURITY
PROBLEM

7. Pres. Trump declares a wall stretching across the U.S – Mexico
border is necessary for national security.
This is an effort to limit international terrorism and criminal
immigration.
The government shutdown lasted from December 22, 2018 to
January 25, 2019 and the longest in U.S history, (Bertrand,
2019).
With federal agents not at work the nation maybe slow to
respond to intelligence information and counterterrorism.
NATIONAL SECURITY
SOLUTION
The government shutdown was not sustainable and unviable
course of action.
Instead Congress are encouraged to reach a bipartisan
agreement regarding funding.
The President has ultimate discretion and makes the final
decisions in security with no veto or input from Congress.
Both Executive and Legislative branch must collaborate and
open government sending agents back to work to maintain
national security.
NATIONAL SECURITY
RECOMMENDATION
Government is responsible for the health and safety of it’s
citizens.
This is achieved through the checks, balances, and powers
granted to the branches of government.

8. Congress has a significant role in developing healthcare policy
and funding national security.
The President manages the departments of national security.
Together the branches of government address problems and find
solutions to concerns facing the nation.
CONCLUSION
REFERENCES
Bertrand, N. (2019). FBI agents say the shutdown is a threat to
national security. The Atlantic. 10
January 2019. Retrieved from:
https://www.theatlantic.com/politics/archive/2019/01/fbi-
agents-say-shutdown-threatens-national-security/580039/
Corrigan, J., Eden, J., Smith, B. (2003). Leadership by example:
Coordinating government roles
in improving health care quality. The National Academies Press.
Washington, D.C. Retrieved from:
https://www.nap.edu/read/10537/chapter/5#71
Meese III, E. (2011). Who is responsible for America’s
security? The Heritage Foundation. 19
August 2011. Retrieved from: https://www.heritage.org/the-
constitution/report/who-responsible-americas-security
West, J. (2019). Top emerging national security threats.
Homeland Security Digital Library. 3 January 2019. Retrieved
from: https://www.hsdl.org/c/top-emerging-national-security-
threats/

9. PowerPoint
Presentation
Rubric
ILO EXEMPLARY 4 ACCOMPLISHED 3 DEVELOPING 2
BEGINNING 1 NO ATTEMPT 0
Content
50% of grade
ILO-IS.B.1
ILO-CL.A.2
ILO-DL.B.3
Both problems are clearly
illustrated including equally
clear opposing solutions. A
minimum of four slides is
used to address each
problem.
Both problems are
addressed along with
opposing solutions. It
may not be clear which
solution is preferable or
why. One problem may
be short of the four-slide
minimum.
Both problems are
addressed, but they’re not

10. clearly illustrated or
solutions may be missing or
unclear. Both problems are
short of the four-slide
minimum, or the slides are
vague and lack details.
Problems are not
clearly illustrated.
Opposing solutions
may be missing
altogether.
No submission
Multimedia
Usage
20% of grade
ILO-SK.B.3
Presentation uses a variety
of graphic, animation, and
sound elements that
enhance, but do not
distract from, the content.
Presentation uses some
graphics and it includes
some animation or sound
elements that enhance

11. the presentation, or
many elements that
distract slightly from the
content.
One form of multimedia is
included, such as graphics,
an animation, or a sound.
Presentation is all
standard text with no
graphics, animations,
or sounds to enhance
the presentation, or
elements used are
inappropriate or
irrelevant.
No submission
Writing Skill
10% of grade
ILO-SK.A.2
ILO-SK.A.3
Submission demonstrates
clear and concise writing
style and a sophisticated
usage of current

12. terminology in the field.
Assignment is generally
free of errors in grammar,
spelling, and formatting.
Submission displays
good writing, grammar,
and formatting with
fewer than five errors.
It demonstrates proper
usage of the field's
current terminology to
the level expected in an
Associate's degree.
Submission reflects basic
writing and grammar with
more than five errors.
Student uses terminology of
the field, but it may be out
of date or used in a less than
precise way.
Topics, concepts, and
ideas are not
coherently discussed
or expressed. There
are numerous errors.
Submission
demonstrates little

13. familiarity with correct
usage of the
terminology of the
field.
No submission
Research Skill
20% of grade
ILO-IS.A.2
ILO-DL.A.4
Submission provides
sophisticated synthesis of
complex body of
information. Submission
incorporates at least of
eight quality references in
assignment including
required course readings
and scholarly literature.
Submission achieves an
appropriate synthesis of
research. Assignment
contains fewer than
eight acceptable
resources.
Submission provides a basic,

14. but borderline perspective of
research abilities. It has
incorporated four or fewer
sources or marginal or
acceptable quality.
Sources used are
inadequate in quantity,
quality, or
incorporation. Non-
credible sources are
cited.
No submission
POLS210 Class Project:
There are three parts to your class project: the first two are
essays. The final part is a PowerPoint
presentation that will display the combined work on the essays.
For each assignment, there will
be detailed instructions and rubrics with scoring criteria
available in the “Assignments” section

15. of the course.
OVERVIEW:
1. You are a White House Staff Member working for a newly
inaugurated President. The
President is preparing the first “State of the Union” address to
Congress which will
outline the president’s vision for addressing current issues
facing the United States.
2. You will research issues to create the President’s address.
The president is not a dictator.
The proposals must consider the Constitution, relevant court
rulings, and public opinion.
3. After you have completed your research of the issues, you
will then create a PowerPoint
presentation reflecting your proposed State of the Union
address. Think of it as your TV
infomercial promoting your plan, and use it to grab the public’s
attention.
Issue essays
Using the “Assignments” section of the classroom, you will
write two essays together with cited
research sources. They will be a minimum of 500 words and a

16. maximum of 600 words per essay,
and you may lose points for going too long! The rubric states an
exemplary essay will be
concise. The topics for the issues will be:
a. Healthcare (due at end of Week 3)
b. National Security (due at end of Week 5)
For each essay, choose a problem within the topic. What are two
competing solutions to this
problem? Explain which one is better and why. How will the
different levels of government be
involved (federal, state and local)? This will require research
into news recent news articles
(published within four weeks of each assignment’s due date).
For each respective week, include
relevant information from the required readings for that week
too.
PowerPoint presentation (due at end of Week 7)
After you have completed your research of the issues for the
essays, you will design and build a
presentation that represents each of the above issues and
proposed solutions. This is an

17. opportunity for you to use your creative side. You will use a
minimum of four slides for each
issue, a title slide, and a slide listing references for a minimum
slide total of ten slides.
Alexis Shipe
POLS210: American Government I
Instructor: Professor K. Cheiken
October 16, 2016
“Healthcare in America”
There are issues within healthcare in America that have
been concerning citizens for many years. For starters back in
2010 the Affordable Care Act, Obamacare, was passed into law
and caused an uproar with courts, Congress, the media and the
people even still till this day (Gass, A1). There are many
supporters, many others want to make a few changes, as well as
those who repeal the law and want it gone for good. Even
though the growth of Americans covered by the Affordable Care
Act has grown to over 25 million, there are some still not
understanding its concept (Gass, A1). The intentions of
Obamacare are to: increase health insurances quality;
affordability; lower uninsured rates; and reducing the cost of
health insurance. Even though the intentions are grand there
have been faults along the way that have been mutating the
Affordable Care Act in a negative manner.
The cost of health care is one of the major concerns of
citizens. It is becoming more expensive, and further increases
are only seen for the near future (ProCon, A1). This is not the
only con that is affecting Americans, there are others such as:
its budget impact on federal deficits; the spending cuts for
Medicare; the effects of primary care physician shortages;
contradictions which results in high costs; high volumes of
patients needing medical attention within emergency rooms; and

18. many others (ProCon, A1). These faults within Obamacare all
have solutions that will take time to implement. Majority of
Americans support or want to make only minor changes to
reform the Affordable Care Act.
One solution would be to propose the Free Choice Voucher
system, thought of by Sen. Ron Wyden. This system was put
into play to defuse the “family glitch” within the Affordable
Care Act (Ehley, A1). Employees were allowed to receive
contributions from the employer if they could not afford
average employer based coverage (Ehley, A1). Another
solution would be to make changes to the way individuals are
qualifying for their coverage plan and to make the subsidy
based off of the person’s annual income from previous years
(Ehley, A1).
The most favorable solution for Obamacare would be to make
changes and to make decisions based off of previous income.
This will allow proof of income, and also allow the individual
to still be able to afford everyday necessities. Another positive
outcome will be that those will not be put into debt, but given
health care they can afford and have refundable tax credits
(Ehley, A1). Health care in America will have its flaws for
decades to come, but the most important thing to remember is to
focus on positive changes. Reform is always scary, but also
may be needed in order to best fit American citizens as a whole
and not majority.
Work Cited:
Ehley, Brianna. “Four Ways to Help Fix Obamacare”. Fiscal
Times. (2014).

19. Gass, Erin & Sorian, Richard. “The Five Healthcare Issues That
Will Dominate the 2016
Election”. FleishmanHillard. (2015).
ProCon. “Top 10 Pros & Cons: Is the Patient Protection and
Affordable Care Act (Obamacare)
Good for America?”. ProCon.org. (2015).
Arnold 3
Elijah Arnold
Professor Tiffany Orcesi
POLS 210
19 June 2017
National Security: A Privacy vs. Security Issue
National security has developed into a multi-agency effort to
thwart domestic and international terrorist attacks. All levels
and branches of government share roles in defending American
freedoms. The Intelligence Community (IC), notably the
National Security Agency (NSA), operates worldwide to protect
the United States from terrorism. Recently, Americans have
revitalized the debate on whether the government should
emphasize on providing security or privacy to its citizens.
A constant threat to National Security looms over us every
second of the day. “N.S. is the use of economic, political, and
military power and influence to maintain its integrity and
political institutions” (Lenz, 401). Congress, under President
Truman, passed the National Security Act in 1947 to officially
establish and delegate authorities to executive branch agencies
like the NSA, which has three primary missions. The NSA,
established in 1952, conducts information assurance, signals

20. intelligence, and network warfare operations to protect us from
threats abroad and at home.
However, it can be argued that NSA amassed exceptional
powers when President Regan signed EO 12333 in 1981, and has
rapidly grown ever since. The President’s Executive Orders
can’t be challenged in court or overturned by congress”
(Brandom). Many justify this argument with NSA’s
technologically advanced tools which circumvent the Fourth
Amendment. “Technology has greatly increased the
government’s power to gather information without ever
physically seizing or searching anything” (Lenz, 350).
The US permitted the NSA’s warrantless and bulk collection
program to persist under President George W. Bush’s 2001
Patriot Act. President Bush utilized the Patriot Act to expand
powers to the IC in support of his War on Terror. The
exclusionary rule and the Fourth Amendment don’t really apply
to the IC due to Section 215 of the Patriot Act. “The Supreme
Court has long held that such information is not privacy-
protected by the Fourth Amendment” (Walpin).
The Department of Justice also plays a vital role in protecting
National Security. Over the last decade, the FBI, local, and state
law enforcement have increasingly been fielded surveillance
technology to pursue domestic and international crime to
include cyber-crime. The article We Need NSA Surveillance
defends the justification in which the NSA conducts operations
by arguing that a police department collecting phone records
from a jewelry store robbery would not void the suspect’s
conviction. In 2012, the FBI along with New Zealand police
raided Kim Dotcom’s mansion in support of shutting down his
online storage locker Megaupload, then subsequently pushed for
extradition to the US to stand trial.
Overall, American’s safety depends on the government’s
effectiveness in combating perpetual threats to National
Security. The NSA and FBI are empowered through legislation
and Executive Orders. The judicial system facilitates serving
justice to cyber criminals and therefore, also protecting

21. National Security. Regardless of opinions on whether the NSA
or the FBI infringe upon privacy, these agencies which make up
part of the IC critically impact the success of protecting the
security of the American people.
Works Cited
Brandom, Russell. "Donald Trump Is about to Control the Most
Powerful Surveillance Machine in History." The Verge. The
Verge, 14 Nov. 2016. Web. 19 June 2017.
<https://www.theverge.com/2016/11/14/13602884/donald-
trump-surveillance-nsa-drone-strike-power>.
Lenz, Timothy O. and Mirya Holman. American Government.
University Press of Florida. 2013.
Walpin, Gerald. "We Need NSA Surveillance." National
Review. N.p., 16 Aug. 2013. Web. 27 June 2017.
<http://www.nationalreview.com/article/355959/we-need-nsa-
surveillance-gerald-walpin>.